Asian consensus recommendations on optimizing the diagnosis and initiation of treatment of hepatitis B virus infection in resource-limited settings

Gane, Edward John and Charlton, Michael R. and Mohamed, Rosmawati and Sollano, Jose Decena and Tun, Kyaw Soe and Pham, Thuy Thi Thu and Payawal, Diana Alcantara and Gani, Rino Alvani and Muljono, David Handojo and Acharya, Subrat Kumar and Zhuang, Hui and Shukla, Akash and Madan, Kaushal and Saraf, Neeraj and Tyagi, Satyendra and Singh, Karam Romeo and Cua, Ian Homer Yee and Jargalsaikhan, Ganbolor and Duger, Davadoorj and Sukeepaisarnjaroen, Wattana and Purnomo, Hery Djagat and Hasan, Irsan and Lesmana, Laurentius Adrianto and Lesmana, Cosmas Rinaldi Adithya and Kyi, Khin Pyone and Naing, Win and Ravishankar, Allampura Chandrashekar and Hadigal, Sanjay (2020) Asian consensus recommendations on optimizing the diagnosis and initiation of treatment of hepatitis B virus infection in resource-limited settings. Journal of Viral Hepatitis, 27 (5). pp. 466-475. ISSN 1352-0504, DOI https://doi.org/10.1111/jvh.13244.

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Abstract

Asia has an intermediate-to-high prevalence of and high morbidity and mortality from hepatitis B virus (HBV) infection. Optimization of diagnosis and initiation of treatment is one of the crucial strategies for lowering disease burden in this region. Therefore, a panel of 24 experts from 10 Asian countries convened, and reviewed the literature, to develop consensus guidance on diagnosis and initiation of treatment of HBV infection in resource-limited Asian settings. The panel proposed 11 recommendations related to diagnosis, pre-treatment assessment, and indications of therapy of HBV infection, and management of HBV-infected patients with co-infections. In resource-limited Asian settings, testing for hepatitis B surface antigen may be considered as the primary test for diagnosis of HBV infection. Pre-treatment assessments should include tests for complete blood count, liver and renal function, hepatitis B e-antigen (HBeAg), anti-HBe, HBV DNA, co-infection markers and assessment of severity of liver disease. Noninvasive tests such as AST-to-platelet ratio index, fibrosis score 4 or transient elastography may be used as alternatives to liver biopsy for assessing disease severity. Considering the high burden of HBV infection in Asia, the panel adopted an aggressive approach, and recommended initiation of antiviral therapy in all HBV-infected, compensated or decompensated cirrhotic individuals with detectable HBV DNA levels, regardless of HBeAg status or alanine transaminase levels. The panel also developed a simple algorithm for guiding the initiation of treatment in noncirrhotic, HBV-infected individuals. The recommendations proposed herein, may help guide clinicians, to optimize the diagnosis and improvise the treatment rates for HBV infection in Asia.

Item Type: Article
Funders: Mylan Pharmaceuticals ltd, BioQuest Solutions Ltd
Uncontrolled Keywords: Algorithm; Asia; Consensus; Diagnosis; Hepatitis B virus
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 05 Nov 2024 02:38
Last Modified: 05 Nov 2024 02:38
URI: http://eprints.um.edu.my/id/eprint/36717

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