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 Associate Professor in Medicine and Gastroenterology at the Medical School of Athens University and the chair of the Academic Gastroenterology Department at Laiko Hospital of Athens.

 

He graduated in Medicine and completed his PhD thesis at the Medical School of Athens University. He trained in Gastroenterology at Tzaneion General Hospital in Piraeus, Greece, and had a 2-year research fellowship in Hepatology at the Royal Free Hospital in London, UK.

 

He served as a member of the Scientific Committee/Governing Board of EASL, the General Secretary of the Hellenic Society of Gastroenterology, the General Secretary of the Hellenic Association for the Study of the Liver and the Chairman of its research committee. He is a member of EASL, AASLD, AGA (fellow) and IASL as well as of several national associations and committees.

 

His main research interest has focused on viral hepatitis, but he has also worked in other research areas of hepatology and gastroenterology. He has authored or co-authored more than 200 articles published in international journals with more than 6,000 citations (h-index 39). He was the co-ordinator of the recent EASL hepatitis B Clinical Practice Guidelines and a member of the working group for the Greek guidelines for both hepatitis B and C. He has served as a reviewer for New Engl J Med, Lancet, Ann Intern Med, and almost all gastroenterology and hepatology journals, as well as for EASL and UEGW abstracts and the EU Framework Programmes for Research.

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