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Ji Hoon Kim
Abstract
The clinical practice guideline for the management of chronic hepatitis B (CHB) was originally enacted in 2004 by the Korean Association for the Study of the Liver in order to provide medical practitioners with specific medical information regarding CHB to help them facilitate their understanding of the disease and treatment of the infected patients. Other than an update on the treatment of antiviral resistance in 2014, which is a partial revision, the guidelines for the treatment of chronic hepatitis B have been revised entirely three times in 2007, 2011, and 2015. Although several major international liver association have established and revised clinical practice guidelines, since the medical environment in each country is somewhat different depending on race, region, institution, and economic conditions, it is necessary to revise the Korean guidelines to that reflect our medical environment and own research results. In this review, major change and its background will be summarized about 2018 updated clinical practice guidelines for the management of CHB.
Figures and Tables
Fig. 1
Algorithm for management of chronic hepatitis B virus infection. Patients under special population (e.g., pregnancy, patients receiving cancer chemotherapy) may require treatment even if immune tolerant or inactive phase. See section on special population. HBsAg, hepatitis B surface antigen; HBeAg, hepatitis B e antigen; anti-HBe, antibody to hepatitis B e antigen; HBV, hepatitis B virus; DNA, deoxyribonucleic acid; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ULN, upper limit of normal. *Serum HBV DNA ≥107 IU/mL; †An upper limit of normal (ULN) for ALT of 34 IU/L for males and 30 IU/L for females; ‡Serum HBV DNA ≥20,000 IU/mL for HBeAg positive patient and HBV DNA ≥2,000 IU/mL for HBeAg negative patient.
Fig. 2
On treatment management of patients receiving oral antivirals. HBV, hepatitis B virus; DNA, deoxyribonucleic acid; LFT, liver function test; HBeAg, hepatitis B e antigen; anti-HBe, antibody to hepatitis B e antigen; HBsAg, hepatitis B surface antigen; Cr, creatinine; Ca, calcium; P, phosphate; CK, creatin kinase; HCC, hepatocellular carcinoma; tenofovir DF, tenofovir dipivoxil fumarate. *When using telbivudine or clevudine; †Assessed after least 6 months of treatment when using low barrier drug, at least 12 months of treatment when using high barrier drug.
Fig. 3
A algorithm of selecting antivirals in bone and renal dysfunction. Tenofovir AF, Tenofovir alafenamide fumarate. *In case of history of antiviral resistance, refer to table 9; †Entecavir needs dose adjustments if creatinine clearance <50 mL/min, refer to table 10; ‡Not indicated if creatinine clearance <15 mL/min; §Not indicated if creatinine clearance <50 mL/min.
Table 1
Definition of Natural Phases of Chronic Hepatitis B in 2015 and 2018 Guideline
CHB, chronic hepatitis B; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; DNA, deoxyribonucleic acid.
aHBV DNA level was defined as “high level” in 2015 guideline, whereas “very high level (≥10,000,000 IU/mL)” in 2018 guideline; bHBV DNA level was defined as “lower level” in 2015 guideline, whereas “high level (≥20,000 IU/mL)” in 2018 guideline.
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