2008 APASL guidelines for HBV management
Yun-Fan Liaw
Liver Rearch Unit, Chang Gung Memorial Hospital and Chang Gung University,
天津培训网
Taipei, Taiwan
Since the third version of Asian-Pacific connsus on the management of hepatitis B was published in June 2005, Pegylated interferon α2a, entecavir and telbivudine have been approved globally and veral updated guidelines on chronic hepatitis B have been published. In addition, large volume of new data on the natural history and treatment of chronic hepatitis B have become available. The include long-term follow-up studies in large community-bad cohorts or asymptomatic subjects with chronic hepatitis B virus (HBV) infection, further studies on the role of HBV genotype/naturally occurring HBV mutations, treatment of drug resistance and new therapies. We have since monitored the progress and held a 2-day expert meeting to review and asss relevant new data. The significance of the reported findings were discusd and debated. The earlier APASL “connsus statement on the management of chronic hepatitis B” (Liver Int 2005;25:472-489) was revid accordingly. The key terms ud in the statement were also defined. The new APASL guidelines are:
Recommendation 1. Thorough evaluation and counlling are mandatory before considering drug therapy (II).
Recommendation 2. Patients with viral replication but persistently normal or minimally
elevated ALT levels should not be treated, except in patients with
advanced fibrosis or cirrhosis. They need adequate follow-up and
HCC surveillance every 3-6 months (I).
Recommendation 3. Prior to therapy, liver biopsy is recommended in patients with HBV
replication and raid ALT level, or tho with high normal ALT
and age over 40 (II).
Recommendation 4. Chronic hepatitis B patients with ALT>2x ULN and HBV-DNA >
2.0 x104 IU/ml (105 copies/ml) if HBeAg positive, or >2.0x103 IU/ml
(104 copies/ml) if HBeAg-negative, should be considered for
treatment (I). Treatment should be started as early as possible in
ca of impending or overt hepatic decompensation (II). Otherwi,
3-6 months obrvation is recommended (II).
Recommendation 5. Patients can be treated with conventional IFN 5-10 mu 3x/week or
divisional
Pegylated IFN-α2a 90-180 μg weekly (I), entecavir 0.5 mg daily (I),
adefovir 10 mg daily (I), telbivudine 600 mg daily (I), or lamivudine
100 mg daily (I). Thymosin-α 1.6 mg 2x/week can also be ud (I).
a christmas carolLamivudine is recommended if there is a concern regarding ensuing
or overt hepatic decompensation (II). Entecavir and telbivudine may
also be ud in this situation (IV).
Recommendation 6. During therapy, ALT HBeAg and/or HBV-DNA should be monitored
at least every 3 months (I). Renal function should be monitored if
agloatadefovir is ud (I). During interferon therapy, monitoring of
adver effects is mandatory (I).
Recommendation 7. After the end of therapy, levels of ALT and HBV-DNA should be
掉头发很厉害怎么办monitored monthly for the first 3 months to detect early relap, and
then every three months(for cirrhotic patients and tho who
remain HBeAg/HBV-DNA positive) to six months (for responders)
(II). For non-responders, further monitoring of HBV markers is
required to recognize a delayed respon and to plan retreatment
when indicated (II).
Recommendation 8.For conventional IFN, the current recommended duration of therapy
守护甜心53
is 4-6 months for HBeAg positive patients(II) and at least a year for
HBeAg negative patients (I). For Peg-IFN, the recommended
duration is at least 6 month for HBeAg positive patients (II) , 12
months for HBeAg negative patients (I). For thymosin α1, the
recommended duration of therapy is 6 months for both HBeAg
positive (I) and negative patients (II).
Recommendation 9.For oral antiviral agents: In HBeAg positive patients, treatment can
be stopped when HBeAg roconversion with undetectable HBV-
DNA has been documented on two parate occasions at least 6
months apart (II). In HBeAg negative patients, it is not clear how
long treatment should be continued, but treatment discontinuation
can be considered if undetectable HBV-DNA has been documented
on three parate occasions 6 months apart. (II).
Recommendation 10. For female patients of child-bearing age, IFN-bad therapy is preferred for nonpregnant women and pregnany is discouraged during IFN-therapy. Women who become pregnant while on oral antiviral drug(s) can continue tretamnet with category B drug(s) (VI).
Recommendation 11. Adefovir, telbivudine or interferon (if CD4>500) is preferred if
patient’s HIV infection does not require treatment. If patient’s HIV
infection requires treatment, tenofovir or lamivudine/tenofovir
combination should be included in the active antiretroviral therapy
(II).
Recommendation 12. In patients with concurrent HCV or HDV infection, determine which
virus is dominant and treat the patients accordingly (III)
Recommendation 13. Lamivudine is the agents of choice for treatment naïve patients with
obvious or impending hepatic decompensation (II). Entecavir and
telbivudine can also be ud (III).
Recommendation 14. Before receiving immunosuppression or chemotherapy, patients
should be screened for HBsAg (III). If HBsAg is positive,
prophylactic therapy with a direct antiviral agent before the start
and up to at least 12 weeks after the end of immunosuppression or
chemotherapy is recommended (I).
Recommendation 15. For patients who developed drug resistance while on lamivudine,
add-on adefovir therapy is indicated (I), switching to entecavir
(1mg/day) is an option (I). For lamivudine naïve patients who
restaurant怎么读developed drug resistance while on adefovir, add-on or switching
to lamivudine, telbivudine or entecavir is indicated (III). For
patients who developed drug resistance while on telbivudine, add-
on adefovir therapy is indicated (IV). Switching to IFN bad
therapy is an option (III)
Recommendation 16-1. Nucleos(t)ide analogue(s) should be commenced in all patients
with HBV-associated liver failure who are listed for
男生服饰搭配transplantation and have detectable HBV-DNA. Lamivudine plus
low do HBIG (400-800 U, i.m. daily for 1 week, followed by 400-
800 U monthly long term) provide safe and effective prophylaxis
against HBV reinfection of the allograft (II). Alternatively,
lamivudine + adefovir prophylaxis can be considered (II)
Recommendation 16-2. Late conversion (at least 12 months post-transplant) HBIG
法硕考研培训substitution by adefovir provides asfe and cost-effective
prophylaxis (II). Late conversion to lamivudine mono-therapy may
be considered in “low-risk” patients (I).动员会主持词
Recommendation 16-3. HBV-naïve patient receiving a liver from anti-HBc (+) donor
should receive long-term prophylaxis with either Lamivudine or
HBIG (III).
