The American Association for the Study of Liver Disease (AASLD), the organization that defines how doctors should treat hepatitis B and other liver ailments, unveiled new hepatitis B treatment guidelines this week at its annual conference in San Francisco.
The new guidelines are published here. Patients should review them and discuss any updates that address their individual conditions with their physicians.
The experts addressed important issues in the updated guidelines, including whether to treat children and young adults who are in the immune-tolerant stage of hepatitis B–with high viral load but no signs of liver damage, and when it is safe to stop antiviral treatment. They also made it “official” that pregnant women with high viral loads should be treated with tenofovir (Viread) during pregnancy to avoid infecting their newborns.
Other issues tackled in the updated guidelines are listed below, along with some observations by Joan Block, executive director and cofounder of the Hepatitis B Foundation. We’ll be featuring other news from AASLD in this blog in the days ahead.
Issues address in AASLD’s updated hepatitis B treatment guidelines:
- Should adults with immune active chronic hepatitis B be treated with antivirals to decrease liver-related complications?
- Should adults and children with immune-tolerant infection — high viral load and normal ALTs (alanine aminotransferase) — meaning no signs of liver damage–be treated with antivirals to decrease liver-related complications?
- Should antivirals be discontinued in people who have lost the hepatitis B e antigen (HBeAg) while on treatment?
- Should antivirals be discontinued in people with HBeAg-negative infection who have achieved sustained, low viral load (HBV DNA) during treatment?
- Does the antiviral entecavir (Baraclude) have a different impact on kidney and bone health than tenofovir?
- Is there a benefit to adding a second antiviral in people with persistently low viral load who are being treated with either tenofovir or entecavir?
- Should people with compensated cirrhosis (liver scarring) and low viral load be treated with antivirals?
- Should pregnant women who are hepatitis B surface antigen (HBsAg) positive with high viral load receive antivirals during their third trimester of pregnancy to prevent perinatal (mother-to-child) transmission of hepatitis B?
- Should children with HBeAg-positive hepatitis B be treated with antivirals to decrease liver-related complications?
Reports from Joan Block about AASLD:
–Hepatitis B Foundation medical director Dr. Bob Gish will be featured at a special session – Beyond the Walls of the Clinic – sponsored by Project Inform, which will discuss the importance of collaboration between clinicians and the community to address viral hepatitis.
— Dr. Anna Lok spoke on Sunday about treatment options for tricky situations such as pregnancy. The updated AASLD HBV guidelines recommend if an infected pregnant woman’s viral load is greater than 1 million IU/mL she should be treated with tenofovir to prevent perinatal transmission. Tenofovir is preferred, but clinical trials have shown that lamivudine and telbivudine are also safe.
— “Within the next decade most liver disease in the U.S. will be self-inflicted, not the result of viral infection or some outside cause,” according to Dr. Ramon Batalier at University of North Carolina.
— Currently, viral hepatitis is a huge silent epidemic in the U.S.; however, fatty liver disease is going to be an enormous liver disease tsunami if steps aren’t taken now to address it.
Final thoughts from the foundation’s President, Dr. Tim Block:
The focus at AASLD is on hepatitis C because there’s truly a revolution going on in regards to the treatment of this virus. But interest in hepatitis B treatment is growing as evidenced by the packed meeting sessions, which is significantly different from years past.
Speakers are noting that there is definitely a shift of scientists moving from hepatitis C to hepatitis B because that’s where the need is now.