Diagnosis and management of chronic hepatitis B in children, young people, and adults: summary of NICE guidance

• Published in: BMJ (Online) 2013-06, Vol.346 (jun26 3), p.f3893-f3893
• Main Authors: Sarri, Grammati, Westby, Maggie, Bermingham, Sarah, Hill-Cawthorne, Grant, Thomas, Howard
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antigens; Antiviral agents; Antiviral Agents - therapeutic use; Biomarkers - blood; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - prevention & control; Child; Child, Preschool; Children; Deoxyribonucleic acid; Diagnosis; Disease Progression; DNA; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Guideline Adherence; Hepatitis; Hepatitis B; Hepatitis B Surface Antigens - blood; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - drug therapy; Humans; Infections; Infectious diseases; Interferon; Liver cancer; Liver diseases; Liver Diseases - blood; Liver Diseases - diagnosis; Liver Diseases - therapy; Liver Neoplasms - blood; Liver Neoplasms - diagnosis; Liver Neoplasms - prevention & control; Male; Medical diagnosis; Patient Education as Topic; Patients; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Referral and Consultation; Risk Assessment; Sentinel Surveillance; United Kingdom; Womens health
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.f3893

About a third of the world's population has serological evidence of past or present HBV infection, and 350-400 million people have chronic HBV infection. 1 In the UK about 326000 people are thought to have chronic hepatitis B. 2 In some people, chronic hepatitis B may cause liver fibrosis, cirrhosis, and hepatocellular carcinoma; in others it is inactive and does not lead to important health problems. 3 Antiviral therapy suppresses HBV replication and decreases the risk of progressive liver disease. 4 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of chronic hepatitis B in children, young people, and adults. 5 Recommendations NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness.Arrange the following tests and include test results with the referral: - Hepatitis B e antigen (HBeAg, an indirect marker of high levels of viraemia and infectivity) or antibody status (anti-HBe, an indirect marker of lower levels of viraemia and infectivity) - HBV DNA level (quantitative direct measure of level of viraemia and infectivity) - IgM antibody to hepatitis B core antigen (IgM anti-HBc, evidence of recent infection with HBV) - Hepatitis C virus antibody (anti-HCV) - Hepatitis delta virus antibody (anti-HDV) - HIV antibody (anti-HIV) - Hepatitis A virus antibody (anti-HAV) - Alanine aminotransferase (ALT) or aspartate aminotransferase, [gamma]-glutamyltransferase, serum albumin, total bilirubin, total globulins, full blood count, and prothrombin time - Tests for hepatocellular carcinoma, including hepatic ultrasound and [alpha] fetoprotein testing.[Based on the experience and opinion of the Guideline Development Group (GDG)] Treatment criteria for adults Offer antiviral treatment to adults after consistent results from two consecutive tests conducted three months apart, as follows: - Patients aged >=30 years who have HBV DNA levels >2000 IU/mL and abnormal ALT - Patients aged 2000 IU/mL and abnormal ALT if there is evidence of necro-inflammation or fibrosis on liver biopsy or a transient elastography score >6 kPa - Patients with HBV DNA levels >20000 IU/mL and abnormal ALT regardless of age or the extent of liver disease - Patients with cirrhosis if any detectable HBV DNA is present, regardless of HBeAg status, HBV DNA levels, and ALT levels.[Based on mo