Chronic hepatitis B : an update
Citations
2,399 citations
Cites background from "Chronic hepatitis B : an update"
...Submitted for publication on January 11, 2018 Some persons may test positive for anti-HBc but not HBsAg; they may or may not also have anti-HBs, with the prevalence depending on local endemicity or the risk group (37, 38)....
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...(iii) Anti-HBc may be the only marker of HBV infection during the window phase of acute hepatitis B; these persons should test positive for anti-HBc immunoglobulin M (37, 38)....
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1,862 citations
1,787 citations
Cites background from "Chronic hepatitis B : an update"
...Identification of a HBV-infected person is helpful to [7, 105]: • detect and evaluate stage of the liver disease and extent of liver damage; • plan antiviral therapy which can delay or reverse the progression of liver disease; • permit ultrasound surveillance to detect HCC at a potentially treatable stage; • counsel to avoid excessive alcohol use; • take measures to reduce risk of transmission to others; • avoid unnecessary vaccination, as vaccination is not beneficial for persons already chronically infected and is unnecessary for persons already immune (either through prior vaccination or a previous resolved acute infection; • vaccinate unprotected individuals....
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...the duration of anti-viral prophylaxis is 6–12 months after completion of chemotherapy [25, 105]....
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1,596 citations
Cites background from "Chronic hepatitis B : an update"
...Background The objective of HBV treatment is to prevent fibrosis progression and liver-related complications through achievement of sustained suppression of viremia.(2) In those with significant inflammation and/or fibrosis on histology and/or elevated ALT in association with elevated HBV DNA levels, the risk of liver-related complications is highest and the rationale for treatment can be made....
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...Assessments are performed on continuous therapy (NAs)(27-30) and after therapy discontinuation (PegIFN).(2,31,32) The best predictor of sustained remission off-treatment is HBsAg loss, but this is infrequently achieved with current therapies....
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1,441 citations
Cites background from "Chronic hepatitis B : an update"
...Patients who have significant liver fibrosis and HBV DNA >2000 IU/ml should be considered for antiviral therapy even if their ALT levels are below two times ULN [251,252]....
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...Among patients who have persistently elevated ALT >2 times ULN and HBV DNA >2000 IU/ml, all regional guidelines recommend commencement of antiviral therapy and liver fibrosis assessment may not be necessary....
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...Among hepatitis B patients who have elevated ALT but not yet reached two times ULN, liver fibrosis assessment can assist the decision of antiviral therapy....
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...Liver biopsy should only be considered in doubtful cases after TE (A1) • LS measurement should be interpreted with caution among patients with elevated ALT, and should not be used in patients with very high ALT levels (>10 x ULN) (A1) Use of non-invasive tests for staging liver disease in NAFLD NAFLD is a very common condition with reported prevalence of approximately 20% in different parts of the world [219,220]....
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...Its main limitation is the impossibility of obtaining results in case of ascites or morbid obesity and its limited applicability in case of obesity and limited operator experience (A1) • TE should be performed by an experienced operator (>100 examinations) following a standardized protocol with the patient, fasting for at least 2 hours, in the supine position, right arm in full abduction, on the midaxillary line with the probe-tip placed in the 9th to 11th intercostal space with a minimum of 10 shots (A1) • Correct interpretation of TE results in clinical practice must consider the following parameters: - IQR/ median value ( 30%), - Serum aminotransferases levels (<5 x ULN), - BMI (use XL probe above 30 kg/m2 or if skin-tocapsule distance is >25 mm), - Absence of extra-hepatic cholestasis, - Absence of right heart failure, or other causes of congestive liver - Absence of ongoing excessive alcohol intake (A1) • Although alternative techniques, such as pSWE/ARFI or 2D-SWE seem to overcome limitations of TE, their quality criteria for correct interpretation are not yet well defined (A1) • At present correct interpretation of pSWE/ARFI results in clinical practice should systematically take into account the potentially confounding parameter: - fasting for at least 2 hours, transaminases levels ( 5 x ULN), absence of extra-hepatic cholestasis and absence or right heart failure (B1) • MR elastography is currently too costly and timeconsuming for routine clinical practice use and seems more suited for research purposes (A1) Endpoints for staging liver fibrosis In patients with viral hepatitis and HIV-HCV coinfection, the clinically relevant endpoints are: (1) detection of significant fibrosis (METAVIR, F P2 or Ishak, P3), which indicates that patients should receive antiviral treatment....
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