BIGG Rec Logo
BIGG Rec Logo
Guideline

Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection

Year of Publication
2015
Issuing Institution
World Health Organization
Links
WHO IRIS,WHO IRIS

Recommendations

22 included recommendations

Persons with chronic hepatitis B infection. NON-INVASIVE ASSESSMENT OF LIVER DISEASE STAGE AT BASELINE AND DURING FOLLOW UP. APRI (aspartate aminotransferase [AST]-to-platelet ratio index) is recommended as the preferred non-invasive test (NIT) to assess for the presence of cirrhosis (APRI score >2 in adults) in resource-limited settings. Transient elastography (e.g. FibroScan) or FibroTest may be the preferred NITs in settings where they are available and cost is not a major constraint

Status
Updated

Recommended in favor

Conditional

CHRONIC HEPATITIS B. Discontinuation of nucleos(t)ide analogues (NAs) therapy may be considered exceptionally in: -- persons without clinical evidence of cirrhosis (or based on APRI score ≤2 in adults); -- and who can be followed carefully long term for reactivation; -- and if there is evidence of HBeAg loss and seroconversion to anti-HBe (in persons initially HBeAg positive) and after completion of at least one additional year of treatment; -- and in association with persistently normal ALT levels and persistently undetectable HBV DNA levels (where HBV DNA testing is available). ›› Where HBV DNA testing is not available: Discontinuation of NA therapy may be considered in persons who have evidence of persistent HBsAg loss and after completion of at least one additional year of treatment, regardless of prior HBeAg status

Status
Maintained

Recommended in favor

Conditional

Monitoring for disease progression and treatment response in persons with CHRONIC HEPATITIS B prior to, during and post-treatment. It is recommended that the following be monitored at least annually: -- ALT level (and AST for APRI), HBsAg, HBeAg, and HBV DNA levels (where HBV DNA testing is available) -- Non-invasive tests (APRI score or FibroScan) to assess for the presence of cirrhosis, in those without cirrhosis at baseline; -- If on treatment, adherence should be monitored regularly and at each visit

Status
Maintained

Recommended in favor

Strong

Monitoring for disease progression and treatment response in persons with CHRONIC HEPATITIS B prior to, during and post-treatment. In persons who do not yet meet the criteria for antiviral therapy: More frequent monitoring for disease progression may be indicated in: persons who have intermittently abnormal ALT levels or HBV DNA levels that fluctuate between 2000 IU/mL and 20 000 IU/mL (where HBV DNA testing is available), and in HIV-coinfected persons

Status
Maintained

Recommended in favor

Conditional

Monitoring for disease progression and treatment response in persons with CHRONIC HEPATITIS B prior to, during and post-treatment. In persons on treatment or following treatment discontinuation: More frequent on-treatment monitoring (at least every 3 months for the first year) is indicated in: persons with more advanced disease (compensated or decompensated cirrhosis); during the first year of treatment to assess treatment response and adherence; where treatment adherence is a concern; in HIV-coinfected persons; and in persons after discontinuation of treatment.

Status
Maintained

Recommended in favor

Conditional

Prevention of mother-to-child HBV transmission using antiviral therapy. In HIV-infected pregnant and breastfeeding women (including pregnant women in the first trimester of pregnancy and women of childbearing age), a once-daily fixed-dose combination of tenofovir + lamivudine (or emtricitabine) + efavirenz is recommended as first-line antiretroviral therapy (ART). This recommendation applies both to lifelong treatment and to ART initiated for prevention of mother-to-child transmission (PMTCT) and then stopped

Status
Maintained

Recommended in favor

Strong

Powered byEpistemonikos Foundation