中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 7
Jul.  2023
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(7): 1553-1559

Interpretation of guidelines for the prevention and treatment of chronic hepatitis B (2022 edition)

DOI: 10.3969/j.issn.1001-5256.2023.07.007

  • Peking University People's Hospital, Peking University Hepatology Institute, Beijing 100044, China

More Information
  • Corresponding author: RAO Huiying, rao.huiying@163.com(ORCID: 0000-0003-2431-3872)
  • Received Date: 2023-05-19
  • Accepted Date: 2023-06-22
  • Published Date: 2023-07-20
    Abstract
  • Guidelines for the prevention and treatment of chronic hepatitis B (2022 edition) are updated and revised based on the research advances in chronic hepatitis B virus infection in China and globally and the previous editions of the guidelines. This article introduces the updates in natural history and the noninvasive diagnosis and treatment of fibrosis. In particular, the guidelines further expand the indications for patients with chronic hepatitis B virus infection, clearly defines the selection of the population benefiting from interferon therapy, and strictly limits the standard of oral nucleos(t)ide analogues. Meanwhile, the guidelines also recommend more active treatment of patients with low-level viremia and children in the immune-tolerant phase. The new edition of the guidelines will provide an important basis for expanding the screening for hepatitis B virus infection, improving diagnostic rate, optimizing treatment regimens, and standardizing clinical management in China.

     

    • FullText(HTML)
  • loading
    • References(51)
  • [1]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Infect Dis Info, 2023, 36(1): 1-17. DOI: 10.3969/j.issn.1007-8134.2023.01.01.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 传染病信息, 2023, 36(1): 1-17. DOI: 10.3969/j.issn.1007-8134.2023.01.01.
    [2]
    World Health Organization. Global hepatitis report, 2017[EB/OL]. [2022-12-24]. https://www.who.int/publications/i/item/9789241565455.
    [3]
    Polaris Observatory Collaborators. HBV progress towards coverage targets[EB/OL]. [2022-12-24]. http://cdafound.org/polaris-countries-dashboard/.
    [4]
    CUI FQ, SHEN LP, LI L, et al. Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy, China[J]. Emerg Infect Dis, 2017, 23(5): 765-772. DOI: 10.3201/eid2305.161477.
    [5]
    Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016-2021: actions for impact[EB/OL]. [2022-12-24]. https://apps.who.int/iris/bitstream/handle/10665/342808/9789240030985-eng.pdf.
    [6]
    Polaris Obervatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: A modelling study[J]. Lancet Gastroenterol Hepatol, 2018, 3(6): 383-403. DOI: 10.1016/S2468-1253(18)30056-6.
    [7]
    LI AY, LIU ZX, SONG YR, et al. Reduction of the occurrence of occult HBV infection in infants by increasing the dose of hepatitis B vaccine: A large prospective cohort study[J]. Emerg Microbes Infect, 2020, 9(1): 1881-1891. DOI: 10.1080/22221751.2020.1808533.
    [8]
    PÉNEAU C, IMBEAUD S, LA BELLA T, et al. Hepatitis B virus integrations promote local and distant oncogenic driver alterations in hepatocellular carcinoma[J]. Gut, 2022, 71(3): 616-626. DOI: 10.1136/gutjnl-2020-323153.
    [9]
    ERKEN R, LOUKACHOV V, van DORT K, et al. Quantified integrated hepatitis B virus is related to viral activity in patients with chronic hepatitis B[J]. Hepatology, 2022, 76(1): 196-206. DOI: 10.1002/hep.32352.
    [10]
    TONG SP, REVILL P. Overview of hepatitis B viral replication and genetic variability[J]. J Hepatol, 2016, 64(1 Suppl): S4-S16. DOI: 10.1016/j.jhep.2016.01.027.
    [11]
    HUANG DQ, LI XH, LE MH, et al. Natural history and hepatocellular carcinoma risk in untreated chronic hepatitis B patients with indeterminate phase[J]. Clin Gastroenterol Hepatol, 2022, 20(8): 1803-1812. e5. DOI: 10.1016/j.cgh.2021.01.019.
    [12]
    YAO KF, LIU JC, WANG J, et al. Distribution and clinical characteristics of patients with chronic hepatitis B virus infection in the grey zone[J]. J Viral Hepat, 2021, 28(7): 1025-1033. DOI: 10.1111/jvh.13511.
    [13]
    Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [14]
    SONNEVELD MJ, CHIU SM, PARK JY, et al. Probability of HBsAg loss after nucleo(s)tide analogue withdrawal depends on HBV genotype and viral antigen levels[J]. J Hepatol, 2022, 76(5): 1042-1050. DOI: 10.1016/j.jhep.2022.01.007.
    [15]
    LI J, MAO RC, LI XL, et al. A novel noninvasive index for the prediction of moderate to severe fibrosis in chronic hepatitis B patients[J]. Dig Liver Dis, 2018, 50(5): 482-489. DOI: 10.1016/j.dld.2017.12.028.
    [16]
    SONG LW, LIU PG, LIU CJ, et al. Quantitative hepatitis B core antibody levels in the natural history of hepatitis B virus infection[J]. Clin Microbiol Infect, 2015, 21(2): 197-203. DOI: 10.1016/j.cmi.2014.10.002.
    [17]
    FAN R, SUN J, YUAN Q, et al. Baseline quantitative hepatitis B core antibody titre alone strongly predicts HBeAg seroconversion across chronic hepatitis B patients treated with peginterferon or nucleos(t)ide analogues[J]. Gut, 2016, 65(2): 313-320. DOI: 10.1136/gutjnl-2014-308546.
    [18]
    CHI H, LI ZD, HANSEN BE, et al. Serum level of antibodies against hepatitis B core protein is associated with clinical relapse after discontinuation of nucleos(t)ide analogue therapy[J]. Clin Gastroenterol Hepatol, 2019, 17(1): 182-191. e1. DOI: 10.1016/j.cgh.2018.05.047.
    [19]
    LI J, GONG QM, XIE PL, et al. Prognostic value of anti-HBc quantification in hepatitis B virus related acute-on-chronic liver failure[J]. J Gastroenterol Hepatol, 2021, 36(5): 1291-1299. DOI: 10.1111/jgh.15310.
    [20]
    WAI CT, CHENG CL, WEE A, et al. Non-invasive models for predicting histology in patients with chronic hepatitis B[J]. Liver Int, 2006, 26(6): 666-672. DOI: 10.1111/j.1478-3231.2006.01287.x.
    [21]
    DONG XQ, WU Z, ZHAO H, et al. Evaluation and comparison of thirty noninvasive models for diagnosing liver fibrosis in Chinese hepatitis B patients[J]. J Viral Hepat, 2019, 26(2): 297-307. DOI: 10.1111/jvh.13031.
    [22]
    LIANG XE, CHEN YP. Clinical application of vibration controlled transient elastography in patients with chronic hepatitis B[J]. J Clin Transl Hepatol, 2017, 5(4): 368-375. DOI: 10.14218/JCTH.2017.00006.
    [23]
    WU SS, KONG YY, PIAO HX, et al. On-treatment changes of liver stiffness at week 26 could predict 2-year clinical outcomes in HBV-related compensated cirrhosis[J]. Liver Int, 2018, 38(6): 1045-1054. DOI: 10.1111/liv.13623.
    [24]
    de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VⅡ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
    [25]
    WANG HY, WEN B, CHANG XY, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis[J]. J Hepatol, 2021, 74(3): 584-592. DOI: 10.1016/j.jhep.2020.09.034.
    [26]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [27]
    WANG Q, ZHAO H, DENG Y, et al. Validation of Baveno VⅡ criteria for recompensation in entecavir-treated patients with hepatitis B-related decompensated cirrhosis[J]. J Hepatol, 2022, 77(6): 1564-1572. DOI: 10.1016/j.jhep.2022.07.037.
    [28]
    WU Z, MA AL, XIE Q, et al. Significant histological changes and satisfying antiviral efficacy in chronic hepatitis B virus infection patients with normal alanine aminotransferase. Antiviral therapy decision in chronic HBV patients with normal ALT[J]. Clin Res Hepatol Gastroenterol, 2021, 45(2): 101463. DOI: 10.1016/j.clinre.2020.05.011.
    [29]
    TERRAULT NA, BZOWEJ NH, CHANG KM, et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology, 2016, 63(1): 261-283. DOI: 10.1002/hep.28156.
    [30]
    TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599. DOI: 10.1002/hep.29800.
    [31]
    MARTIN P, NGUYEN MH, DIETERICH DT, et al. Treatment algorithm for managing chronic hepatitis B virus infection in the United States: 2021 update[J]. Clin Gastroenterol Hepatol, 2022, 20(8): 1766-1775. DOI: 10.1016/j.cgh.2021.07.036.
    [32]
    ALSHUWAYKH O, DAUGHERTY T, CHEUNG A, et al. Incidence of hepatocellular carcinoma in chronic hepatitis B virus infection in those not meeting criteria for antiviral therapy[J]. Hepatol Commun, 2022, 6(11): 3052-3061. DOI: 10.1002/hep4.2064.
    [33]
    World Health Organization. Guidelines for the prevention care and treatment of persons with chronic hepatitis B infection: Mar 15[R]. Geneva: World Health Organization, 2015.
    [34]
    CHOI HSJ, TONTHAT A, JANSSEN HLA, et al. Aiming for functional cure with established and novel therapies for chronic hepatitis B[J]. Hepatol Commun, 2022, 6(5): 935-949. DOI: 10.1002/hep4.1875.
    [35]
    HOU JL, ZHAO W, LEE C, et al. Outcomes of long-term treatment of chronic HBV infection with entecavir or other agents from a randomized trial in 24 countries[J]. Clin Gastroenterol Hepatol, 2020, 18(2): 457-467. e21. DOI: 10.1016/j.cgh.2019.07.010.
    [36]
    LIU Y, CORSA AC, BUTI M, et al. No detectable resistance to tenofovir disoproxil fumarate in HBeAg+ and HBeAg- patients with chronic hepatitis B after 8 years of treatment[J]. J Viral Hepat, 2017, 24(1): 68-74. DOI: 10.1111/jvh.12613.
    [37]
    CHOI J, KIM HJ, LEE J, et al. Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B: A Korean nationwide cohort study[J]. JAMA Oncol, 2019, 5(1): 30-36. DOI: 10.1001/jamaoncol.2018.4070.
    [38]
    YIP TCF, WONG VWS, CHAN HLY, et al. Tenofovir is associated with lower risk of hepatocellular carcinoma than entecavir in patients with chronic HBV infection in China[J]. Gastroenterology, 2020, 158(1): 215-225. e6. DOI: 10.1053/j.gastro.2019.09.025.
    [39]
    HSU YC, WONG GLH, CHEN CH, et al. Tenofovir versus entecavir for hepatocellular carcinoma prevention in an international consortium of chronic hepatitis B[J]. Am J Gastroenterol, 2020, 115(2): 271-280. DOI: 10.14309/ajg.0000000000000428.
    [40]
    SU F, BERRY K, IOANNOU GN. No difference in hepatocellular carcinoma risk between chronic hepatitis B patients treated with entecavir versus tenofovir[J]. Gut, 2021, 70(2): 370-378. DOI: 10.1136/gutjnl-2019-319867.
    [41]
    LI M, LV TT, WU SS, et al. Tenofovir versus entecavir in lowering the risk of hepatocellular carcinoma development in patients with chronic hepatitis B: A critical systematic review and meta-analysis[J]. Hepatol Int, 2020, 14(1): 105-114. DOI: 10.1007/s12072-019-10005-0.
    [42]
    CHOI WM, YIP TCF, LIM YS, et al. Methodological challenges of performing meta-analyses to compare the risk of hepatocellular carcinoma between chronic hepatitis B treatments[J]. J Hepatol, 2022, 76(1): 186-194. DOI: 10.1016/j.jhep.2021.09.017.
    [43]
    AGARWAL K, BRUNETTO M, SETO WK, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[J]. J Hepatol, 2018, 68(4): 672-681. DOI: 10.1016/j.jhep.2017.11.039.
    [44]
    BYUN KS, CHOI J, KIM JH, et al. Tenofovir alafenamide for drug-resistant hepatitis B: A randomized trial for switching from tenofovir disoproxil fumarate[J]. Clin Gastroenterol Hepatol, 2022, 20(2): 427-437. e5. DOI: 10.1016/j.cgh.2021.04.045.
    [45]
    LI ZB, LI L, NIU XX, et al. Switching from entecavir to tenofovir alafenamide for chronic hepatitis B patients with low-level viraemia[J]. Liver Int, 2021, 41(6): 1254-1264. DOI: 10.1111/liv.14786.
    [46]
    LIU Z, JIN Q, ZHANG Y, et al. 96 week treatment of tenofovir amibufenamide and tenofovir disoproxil fumarate in chronic hepatitis B patients[J/OL]. J Clin Transl Hepatol, 2023, 11(3): 649-660. DOI: 10.14218/JCTH.2022.00058.
    [47]
    FAN R, PAPATHEODORIDIS G, SUN J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis[J]. J Hepatol, 2020, 73(6): 1368-1378. DOI: 10.1016/j.jhep.2020.07.025.
    [48]
    SUN YM, WU XN, ZHOU JL, et al. Persistent low level of hepatitis B virus promotes fibrosis progression during therapy[J]. Clin Gastroenterol Hepatol, 2020, 18(11): 2582-2591. e6. DOI: 10.1016/j.cgh.2020.03.001.
    [49]
    LU Y, SONG YR, ZHAI XJ, et al. Maternal hepatitis B e antigen can be an indicator for antiviral prophylaxis of perinatal transmission of hepatitis B virus[J]. Emerg Microbes Infect, 2021, 10(1): 555-564. DOI: 10.1080/22221751.2021.1899055.
    [50]
    ZHU SS, DONG Y, XU ZQ, et al. A retrospective study on HBsAg clearance rate after antiviral therapy in children with HBeAg-positive chronic hepatitis B aged 1-7 years[J]. Chin J Hepatol, 2016, 24(10): 738-743. DOI: 10.3760/cma.j.issn.1007-3418.2016.10.005.

    朱世殊, 董漪, 徐志强, 等. 1~7岁慢性乙型肝炎HBeAg阳性儿童经抗病毒治疗HBsAg清除率的回顾性研究[J]. 中华肝脏病杂志, 2016, 24(10): 738-743. DOI: 10.3760/cma.j.issn.1007-3418.2016.10.005.
    [51]
    JONAS MM, LOK ASF, MCMAHON BJ, et al. Antiviral therapy in management of chronic hepatitis B viral infection in children: A systematic review and meta-analysis[J]. Hepatology, 2016, 63(1): 307-318. DOI: 10.1002/hep.28278.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (2480) PDF downloads(738) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return