Hepatitis B: Who and when to treat?

Abstract

As current treatment options almost never achieve eradication of hepatitis B virus (HBV), the most realistic goal for HBV treatment is persistent inhibition of viral replication and ALT normalization. Thus, the decision to start treatment should be based on careful patient selection and individualized decisions. Treatment is generally indicated in chronic hepatitis B patients with HBV DNA >2000 IU/mL, elevated ALT and/or at least moderate histological lesions, while all patients with cirrhosis and detectable HBV DNA should be treated. Patients with HBV DNA >20 000 IU/mL and ALT >2xULN (upper limit of normal), HBV DNA >2000 IU/mL and liver stiffness >9 or >12 kPa in case of normal or ≤5xULN, HBV DNA >2000 IU/mL and a family history of cirrhosis and/or HCC as well as HBeAg‐positive patients with HBV DNA >20 000 IU/mL and over 30 years old can begin treatment whatever the liver histology. Moreover, patients with HBV DNA >2000 IU/mL and at least moderate histological lesions can begin treatment whatever the ALT levels. Prophylactic treatment is indicated in HBV‐related liver transplantation patients to prevent recurrence, in the last trimester of pregnancy in women with high viraemia to prevent vertical transmission and in patients receiving immunosuppression/chemotherapy to prevent the reactivation of HBV. Treatment is also indicated in patients with co‐infections, extrahepatic manifestations and severe acute hepatitis B, or healthcare workers with viraemia. These treatment indications can only change if HBV eradication or at least HBsAg clearance can be achieved in the future in a significant proportion of patients.

 

KEYWORDS
cirrhosis, HBsAg, HBV DNA, hepatitis B, hepatocellular carcinoma, treatment indications

 

About Speaker

Georgios PAPATHEODORIDIS

Associate Professor in Medicine & Gastroenterology

Greece

City: Athens

Institution: Athens University Medical School, Laiko General / Hospital, Athens, Greece

Contact: gepapath@med.uoa.gr


Biography of Georgios PAPATHEODORIDIS

George Papatheodoridis is Professor in Medicine and Gastroenterology at Medical School of the National and Kapodistrian University of Athens and Director of the Academic Gastroenterology Department of Laiko Hospital of Athens, Greece. He was trained in Medicine and completed his PhD thesis on “Acute on Chronic Hepatitis B” at the Medical School of Athens University. He was trained in Gastroenterology at Tzaneion Hospital of Piraeus, Greece and had a 2-year research fellowship in Hepatology at the Royal Free Hospital of London, UK.

 

He served as member of the Scientific Committee/Governing Board of EASL and is member of EASL and AASLD (fellow). He is president of the Hellenic Association for Study of Liver, president of Hellenic Foundation of Gastroenterology & Nutrition, chair of the Scientific Committee for Viral Hepatitis of Hellenic Center for Prevention of Diseases and chair of the committee for the implementation of the Hellenic National Plan for hepatitis C elimination. He was general secretary of Hellenic Society of Gastroenterology and Hellenic Association for Study of Liver.

 

His main research interest has been focused on viral hepatitis. He has (co-)authored >260 papers published in PubMed journals having total
IF>1650 and >12000/18500 citations (h-index 54/68) in Scopus/Google Scholar. He was Associate Editor of Liver International and has served as Editorial Board member of other international journals and as reviewer for all gastroenterology/Hepatology journals, many major internal medicine journals (New Engl J Med, Lancet, Ann Intern Med, BMJ etc), ILC/EASL-UEGW abstracts, EU 7 th Framework Programme for research and Horizon 2020. He has given >135 lectures, chaired >45 lectures/round tables and presented >260 abstracts in international meetings.

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