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UK, Canadian & Japanese vs European, American & Asian-Pacific HepB GUIDELINES
As opposed to European (EASL) 2012, Asian-Pacific (APASL) 2012, American (AASLD) 2009, and World Health Organisation (WHO) 2015 major guidelines for the treatment of chronic Hepatitis B, the following 3 guidelines are more strict on the conditions leading to necessity of treatment for Hepatitis B, HBeAg negative carriers:
Canadian 2009, Japanese (JSH) 2013, and UK/British (NICE) 2013 guidelines are more "strict" when it comes to treatment of negative HBsAg patients, especially in the way they consider the ALT value. The treatment necessity criteria of these 3 guidelines can roughly be summarised in the words of NICE 2013 guidelines:
"Offer antiviral treatment to adults aged 30 years and older who have HBV DNA greater than 2000 IU/ml and abnormal ALT (greater than or equal to 30 IU/L in males and greater than or equal to 19 IU/L in females) on 2 consecutive tests conducted 3 months apart."
So there is a very significant difference between the upper 2 groups of the guidelines, as ALT of most of negative HBeAg carriers often varies and is for many often between 30 and 40. The very important question arrises here, and that is for those who have HBV DNA > 2000 and whose ALT usually is between 30 and 40, should they follow the first group of guidelines which recommend no treatment for those HepB carriers, or the second group of guidelines that do recommend such patients to be treated!!!
What are your perspectives on this crucial issue on treatment (necessity of medications)???
Canadian 2009, Japanese (JSH) 2013, and UK/British (NICE) 2013 guidelines are more "strict" when it comes to treatment of negative HBsAg patients, especially in the way they consider the ALT value. The treatment necessity criteria of these 3 guidelines can roughly be summarised in the words of NICE 2013 guidelines:
"Offer antiviral treatment to adults aged 30 years and older who have HBV DNA greater than 2000 IU/ml and abnormal ALT (greater than or equal to 30 IU/L in males and greater than or equal to 19 IU/L in females) on 2 consecutive tests conducted 3 months apart."
So there is a very significant difference between the upper 2 groups of the guidelines, as ALT of most of negative HBeAg carriers often varies and is for many often between 30 and 40. The very important question arrises here, and that is for those who have HBV DNA > 2000 and whose ALT usually is between 30 and 40, should they follow the first group of guidelines which recommend no treatment for those HepB carriers, or the second group of guidelines that do recommend such patients to be treated!!!
What are your perspectives on this crucial issue on treatment (necessity of medications)???
https://www.rcplondon.ac.uk/update/nice-publishes-ncgc-produced-guideline-hepatitis-b
states:
"NICE has published a clinical guideline produced by the National Clinical Guideline Centre (NCGC) on the diagnosis and management of chronic hepatitis B. It aims to ensure the growing number of people with this potentially life-threatening disease are referred to a specialist and receive the right treatments."
It is clear that Brits had stepped out, as they themself say, aiming to ensure that more hepatitis B people will receive the treatment... they "relaxed" the criteria for treatment, suggesting that people who have DNA>2000IU and ALT>= 30 on 2 measurements 3 months apart should be offered treatment.
states:
"NICE has published a clinical guideline produced by the National Clinical Guideline Centre (NCGC) on the diagnosis and management of chronic hepatitis B. It aims to ensure the growing number of people with this potentially life-threatening disease are referred to a specialist and receive the right treatments."
It is clear that Brits had stepped out, as they themself say, aiming to ensure that more hepatitis B people will receive the treatment... they "relaxed" the criteria for treatment, suggesting that people who have DNA>2000IU and ALT>= 30 on 2 measurements 3 months apart should be offered treatment.
Correction: Canadian guidelines are from 2012, not from 2009 as I initially mentioned.
Good points regarding on how establishment of effectiveness and safety of Tenofovir/Entecavir leads on impact on treatment decisions, as well as the future role of qHBsAg.
Guidelines are just guideline, they are not absolute, but they are the consensus opinions of a group of leading practitioners based on latest scientific and clinical evidence. As you can see, guidelines do change and evolve over the years.
As the long term effectiveness and safety of Tenofovir/Entecavir are established, there will be a tendency to treat whenever there is an elevated viral load.
Fibroscan score and qHbsAg will also become more important factors in determining when and how to treat.
What is clear is that there is a huge unmet demand for more treatment drugs and a cure.
Just my opinion.
As the long term effectiveness and safety of Tenofovir/Entecavir are established, there will be a tendency to treat whenever there is an elevated viral load.
Fibroscan score and qHbsAg will also become more important factors in determining when and how to treat.
What is clear is that there is a huge unmet demand for more treatment drugs and a cure.
Just my opinion.
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