Updated AASLD guidance released on HBV prevention, diagnosis, and treatment
medwireNews: The American Association for the Study of Liver Diseases (AASLD) has issued a guidance statement for chronic hepatitis B virus (HBV), covering topics ranging from screening and prevention through to the clinical management of patients.
The authors say that the guidance is meant to complement the 2016 AASLD practice guidelines for treating chronic HBV and update the 2009 guidelines.
They note, however, that unlike the practice guidelines, which were based on a comprehensive systematic review of the literature with associated grading of the level of evidence, the current guidance was generated by consensus of an expert panel following a literature review.
“Intended for use by health care providers, this guidance identifies preferred approaches to the diagnostic, therapeutic, and preventive aspects of care for patients with [chronic HBV],” write Norah Terrault (University of California, San Francisco, USA) and co-authors.
But they caution: “This guidance does not seek to dictate a ‘one size fits all’ approach for the management of [chronic HBV]. Clinical considerations may justify a course of action that differs from this guidance.”
The document is split into six sections, each focusing on a specific aspect of HBV, beginning with screening, counseling, and prevention, and ending with the management of chronic HBV in special populations, such as HBV patients who are coinfected with hepatitis C or D virus, those receiving immunosuppressive or cytotoxic therapy, and those with acute disease.
The final part of the document reproduces the recommendations from the 2016 practice guidelines, and includes new statements from the guidance authors, often incorporating data from studies published since the 2016 guidelines were released.
For instance, the practice guidelines recommend pegylated interferon, entecavir, or tenofovir disoproxil fumarate as the preferred initial treatment for adult patients with immune-active chronic HBV. But the guidance states that tenofovir alafenamide (TAF) can also be considered for these patients. Terrault et al also advise clinicians to consider TAF or entecavir for patients who have or are at risk for renal dysfunction or bone disease, but caution against the use of TAF in individuals with a creatinine clearance rate of less than 15 mL/min or those on dialysis.
“The AASLD 2018 Hepatitis B Guidance provides a data-supported approach to screening, prevention, diagnosis, and clinical management of patients with hepatitis B,” the guidance authors summarize in Hepatology.
And they conclude that the document “provides general guidance to optimize the care of the majority of patients and should not replace clinical judgement for a unique patient.”
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