When to Start and Stop Hepatitis B Treatment: Can One Set of Criteria Apply to All Patients Regardless of Age at Infection?
Authors: Bulent Degertekin, Anna S.F. Lok
Journal: Annals of Internal Medicine (2007)

Editorials3 July 2007When to Start and Stop Hepatitis B Treatment: Can One Set of Criteria Apply to All Patients Regardless of Age at Infection?Bulent Degertekin, MD and Anna S.F. Lok, MDBulent Degertekin, MDFrom the University of Michigan Health System, Ann Arbor, MI 48109.Search for more papers by this author and Anna S.F. Lok, MDFrom the University of Michigan Health System, Ann Arbor, MI 48109.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-1-200707030-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Existing guidelines for the treatment of hepatitis B virus (HBV) infection recommend that only patients with active or advanced liver disease and high serum HBV DNA levels be treated and that, in patients who are initially seropositive for hepatitis B e antigen (HBeAg), treatment can be stopped 6 months after HBeAg seroconversion (1–3). In this issue, Lai and Yuen (4) raise concern that those recommendations are inappropriate for patients with perinatal HBV infection. They propose that patients with normal alanine aminotransferase (ALT) levels who acquire infection early in life should also be treated and that HBeAg-positive patients should continue treatment ...References1. Liaw YF, Leung N, Guan R, Lau GK, Merican I, McCaughan G, et al; Asian-Pacific Consensus Update Working Party on Chronic Hepatitis B. Asian-Pacific Consensus Statement on the management of chronic hepatitis B: a 2005 update. Liver Int. 2005;25:472-89. [PMID: 15910483] CrossrefMedlineGoogle Scholar2. de Franchis R, Hadengue A, Lau G, Lavanchy D, Lok A, McIntyre N, et al; EASL Jury. EASL International Consensus Conference on Hepatitis B. 13-14 September, 2002 Geneva, Switzerland. Consensus statement (long version). J Hepatol. 2003;39 Suppl 1 S3-25. [PMID: 14708673] MedlineGoogle Scholar3. Lok AS, McMahon BJ; Practice Guidelines Committee. American Association for the Study of Liver Diseases (AASLD). Chronic hepatitis B: update of recommendations. Hepatology. 2004;39:857-61. [PMID: 14999707] CrossrefMedlineGoogle Scholar4. Lai CL, Yuen MF. The natural history and treatment of chronic hepatitis B: a critical evaluation of standard treatment criteria and end points. Ann Intern Med. 2007;147:58-61. LinkGoogle Scholar5. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007;45:507-39. [PMID: 17256718] CrossrefMedlineGoogle Scholar6. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137:1-10. [PMID: 12093239] LinkGoogle Scholar7. Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ. 2004;328:983. [PMID: 15028636] CrossrefMedlineGoogle Scholar8. Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO, et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut. 2005;54:1610-4. [PMID: 15871997] CrossrefMedlineGoogle Scholar9. Nguyen M, Trinh H, Garcia T, Ahmed A, Keeffe E. Significant histologic disease in HBV-infected patients with normal to minimally elevated ALT levels at initial evaluation [Abstract]. Hepatology. 2005;42:593A. Abstract no. 1008. Google Scholar10. Lai M, Hyatt B, Afdahl N. Role of liver biopsy in patients with normal ALT and high HBV DNA [Abstract]. Hepatology. 2005;42:720A. Abstract no. 1322. Google Scholar11. Yim HJ, Lok AS. Natural history of chronic hepatitis B virus infection: what we knew in 1981 and what we know in 2005. Hepatology. 2006;43:S173-81. [PMID: 16447285] CrossrefMedlineGoogle Scholar12. Chu CM, Hung SJ, Lin J, Tai DI, Liaw YF. Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels. Am J Med. 2004;116:829-34. CrossrefMedlineGoogle Scholar13. Chu CJ, Hussain M, Lok AS. Quantitative serum HBV DNA levels during different stages of chronic hepatitis B infection. Hepatology. 2002;36:1408-15. [PMID: 12447866] CrossrefMedlineGoogle Scholar14. Carman WF, Jacyna MR, Hadziyannis S, Karayiannis P, McGarvey MJ, Makris A, et al. Mutation preventing formation of hepatitis B e antigen in patients with chronic hepatitis B infection. Lancet. 1989;2:588-91. [PMID: 2570285] CrossrefMedlineGoogle Scholar15. Hsu YS, Chien RN, Yeh CT, Sheen IS, Chiou HY, Chu CM, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology. 2002;35:1522-7. [PMID: 12029639] CrossrefMedlineGoogle Scholar16. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, Chang TT, Kitis G, Rizzetto M, et al; Adefovir Dipivoxil 438 Study Group. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B. N Engl J Med. 2005;352:2673-81. [PMID: 15987916] CrossrefMedlineGoogle Scholar17. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, Chang TT, Kitis G, Rizzetto M, et al; Adefovir Dipivoxil 438 Study Group. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years. Gastroenterology. 2006;131:1743-51. [PMID: 17087951] CrossrefMedlineGoogle Scholar18. Chang T, Chao YC, Kaymakoglu S, Cheinquer H, Pesoa M, Gish R, et al. Entecavir maintained virologic suppression through 3 years of treatment in antiviral naive HBeAg(+) patients (ETV 022/901) [Abstract]. Hepatology. 2006;44:229A. Abstract no. 109. Google Scholar19. Perrillo RP, Lai CL, Liaw YF, Dienstag JL, Schiff ER, Schalm SW, et al. Predictors of HBeAg loss after lamivudine treatment for chronic hepatitis B. Hepatology. 2002;36:186-94. [PMID: 12085364] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Michigan Health System, Ann Arbor, MI 48109.Grant Support: By Ufuk University Faculty of Medicine, Ankara, Turkey (Dr. Degertekin), and the Tuktawa Fund for Liver Research and Education at the University of Michigan (Dr. Lok). Dr. Lok is supported in part by National Institutes of Health contract N01 DK-9-2323 and grants U01 DK57577 and U01 DK62498.Disclosures: Consultancies: A.S.F. Lok (Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Idenix, Innogenetics, Pharmasset, Roche, Schering-Plough); Grants received: A.S.F. Lok (Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Idenix, Innogenetics, Roche, Schering-Plough).Corresponding Author: Anna S.F. Lok, MD, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI 48109-0362; e-mail, [email protected]umich.edu.Current Author Addresses: Drs. Degertekin and Lok: Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI 48109-0362. 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