Introduction
< span>In March 2022, the Gastroenterology Society of Australia (GESA) issued recommendations for the management of hepatitis B, with the aim of improving current understanding of hepatitis B management, including the identification of hepatitis B patients, the timing of starting antiviral therapy, and immunocompromised Hepatitis B reactivation management in patients, etc. This article compiles and organizes the consensus recommendations of the guideline to provide reference for clinicians.
2022 GESA Consensus Recommendations: Management of Hepatitis B
< span>1. At least all populations with an elevated prevalence (≥2%) of chronic hepatitis B (CHB), a high risk of transmission, and/or an increased risk of adverse hepatitis B virus (HBV) infection outcomes should be tested to identify its HBV infection status. (C1)
2. All patients with CHB should have a culturally and linguistically appropriate discussion on the management of CHB (using certified interpreter). (C1)
3. The upper limit of normal serum alanine aminotransferase (ALT) should be 19 IU/L in women and 30 in men IU/L. (C1)
4. Evaluation of CHB-infected patients should include repeated evaluations (eg, HBV serology, ALT, HBV DNA levels) to determine Stage of disease and treatment requirements. (A1)
5. All patients with CHB should be assessed for non-invasive liver fibrosis as part of the initial assessment. (A1)
6. Liver biopsy should be considered only if the results of liver biopsy affect subsequent management (eg, indeterminate fibrosis stage). or coexisting diseases). (A1)
7. Treatment is generally not recommended for patients with chronic hepatitis B e antigen (HBeAg)-positive infection with persistently normal ALT. Antiviral therapy may be considered in some cases (Table 1). (B1)
8 For HBeAg-positive chronic hepatitis patients, antiviral therapy is indicated for HBV DNA > 20,000 IU/mL and persistently elevated ALT or evidence of fibrosis. (A1)
9. For HBeAg-negative chronic hepatitis patients, the indication for antiviral therapy is HBV DNA>2000 IU/mL and persistent ALT Elevated or with evidence of fibrosis. (A1)
10. All patients with cirrhosis and detectable HBV DNA, regardless of ALT level, should receive antiviral therapy. (A1)
11. When oral antiviral therapy is indicated, a potent nucleoside (acid) with a high resistance barrier should be used. ) analogs (entecavir, tenofovir). (A1)
12. Interferon-based therapy is contraindicated in patients with decompensated cirrhosis. (B1)
13. All patients receiving antiviral therapy should receive regular examinations, including ALT, serum HBV DNA, and receive tenofo Renal function [estimated glomerular filtration rate (eGFR)] and serum phosphate were checked in patients treated with vir. (A1)
14. For those who achieved HBeAg seroconversion or sustained hepatitis B surface antigen (HBsAg) clearance after a period of treatment consolidation In patients without cirrhosis, discontinuation of oral antiviral therapy may be considered. However, regular monitoring after treatment has been discontinued, preferably in consultation with a clinician experienced in hepatitis B treatment. (B2)
15. All patients with cirrhosis and non-cirrhotic patients at increased risk of HCC should be monitored for HCC (Table 2). (C1)
16. For CHB patients requiring HCC surveillance, liver ultrasonography should be performed every 6 months. (B1)
17. For individuals assessed to be at high baseline risk for HCC, HCC surveillance should be continued if HBsAg clearance is observed (Table 1). 2). (C1)
18. Patients with acute-on-chronic liver failure should be managed after consultation with the liver transplant unit. (C1)
19. Patients with extrahepatic manifestations of CHB should receive antiviral therapy. (C1)
20. CHB patients should be screened for metabolic comorbidities such as obesity, diabetes, hypertension and dyslipidemia, and carried out Best management. (C1)
21. All pregnant women should be tested for HBsAg during prenatal screening. HBsAg-positive women should receive HBV infection (ALT, HBeAg, HBV DNA) and the presence of clinical liver diseaseevaluation of. (A1)
22. High viral load (>200000 or 5.3 log10 IU/mL) should be treated with tenofovir starting at week 28 to reduce the risk of perinatal hepatitis B transmission. (A1)
23. Infants born to HBsAg-positive mothers should be vaccinated with hepatitis B immune globulin (HBIg) and hepatitis B as soon as possible after birth Vaccine (preferably within 4 hours). Infants should receive routine HBV vaccination at 2, 4, and 6 months of age. (A1)
24. Children born to HBsAg-positive women should be tested for HBsAg and hepatitis B surface antibody 3 months after the last vaccination (anti-HBs) to determine vaccine response and exclude mother-to-child transmission. (A1)
25. HBsAg-positive patients receiving cancer chemotherapy or intermediate-high-risk immunosuppressive therapy for non-malignant disease should receive entecavir or tenor Fovir treatment. (B1)
26. HBsAg-negative/hepatitis B core antibody (anti- HBc) positive patients should be treated with entecavir or tenofovir. (B1)
27. For HBsAg-positive patients receiving low-risk immunosuppressive therapy for non-malignant disease, 3 months of ALT and 6 Monthly HBV DNA testing to monitor hepatitis B reactivation. (B1)
28. All HBsAg-positive patients should be tested for hepatitis C virus (HCV), human immunodeficiency virus ( HIV) and HDV testing, and regularly if there is a risk of persistent infection. (B1)
29. HBsAg-positive patients receiving direct antiviral (DAA) therapy for hepatitis C are at high risk of HBV reactivation. Patients with cirrhosis or other patients who meet the treatment criteria for hepatitis B should receive entecavir or tenofovir. (C1)
30. The risk of HBV reactivation in HBsAg-negative, anti-HBc-positive patients receiving DAA therapy is very low. There is no need to monitor for HBV reactivation. (B1)
31. Regardless of HBV disease stage, the treatment of HBV-HIV co-infection should be combined with HBV highly active antiretroviral therapy ( including tenofovir) in combination. (B1)
32. Entecavir (adjusted dose) or tenofovir alafenamide fumarate (TAF) are established renal impairment Antiviral therapy of choice for HBsAg-positive patients. (B1)
Note: Evidence quality: A=high; B=moderate; C=low; D=very low; strength of recommendation: 1 =strong;2=weak
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