Best practice in the treatment of chronic hepatitis B: A summary of the European Viral Hepatitis Educational Initiative (EVHEI)☆☆☆
Hepatitis B causes acute and chronic hepatitis, the latter resulting in cirrhosis and hepatocellular carcinoma. There are four phases of infection: during the phases of immune tolerance and immune control of the virus, no treatment is recommended but in the phases of immune clearance and immune escape, viraemia with biopsy evidence of significant fibrosis requires anti-viral therapy. The areas of agreement and disagreement between the various consensus statements are discussed. Health economic issues indicate that a trial of pegylated interferon should be offered in non-cirrhotic cases, particularly those that are HBe antigen positive, followed in those that do not establish a sustained viral response, by long term viral suppressive therapy with nucleoside analogues singly or in combination. The indications for treatment and methods of follow-up, as well as issues of viral resistance are discussed.
Keywords: Natural history of CHB, Immune tolerance, Immune clearance, Immune control and immune escape phases, Pegylated interferon and nucleoside therapies, Indications for treatment
☆ This article is based on the proceedings of the 2nd European Viral Hepatitis Educational Initiative (EVHEI) workshop held in Frankfurt, Germany, on 23–24 November 2006. The EVHEI faculty includes: Howard Thomas, MD (Chair), Ferrucio Bonino, MD, Graham Foster, MD, Stephanos Hadziyannis, MD, Michael Manns (Co-chair), MD, Patrick Marcellin, MD, Rafael Esteban-Mur, MD, Jean-Michel Pawlotsky, MD, Christian Trépo, MD, Ran Tur-Kaspa, MD, and Fabien Zoulim, MD.
☆☆ The author declares that the manuscript was developed by Howard C. Thomas (H.C.T.) in conjunction with International Medical Press. EVHEI is run by International Medical Press and is in receipt of educational grants from BMS and Valeant. The article is based on a paper presented at the meeting by H.C.T. The participants travel and accommodation were supported by the meeting’s sponsors. The author attends the International Advisory Boards of BMS, Genome Sciences, Roche, Gilead and Idenix/Novartis.
PII: S0168-8278(07)00413-8
doi:10.1016/j.jhep.2007.07.017
© 2007 Published by Elsevier Inc.
