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Expansion of Access to HBV Treatment

  • Hepatitis B (J Lim, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Chronic hepatitis B is a substantial burden on health care systems. It will remain a cause of substantial morbidity and mortality for several decades, despite effective vaccination programs. Barriers to expanding therapy for hepatitis B in resource-limited settings include a limited understanding of the prevalence of the disease and its distribution, limited data on treatment efficacy in low income countries, and limited infrastructural resources to perform appropriate diagnostic and monitoring assays. Surveillance for hepatitis B virus (HBV) varies widely in its methods and completeness. Antiviral treatments for hepatitis B have reduced in costs and have become affordable through generic production and subsidies. Antiviral therapy can be targeted to the active phases of CHB when the risk of disease progression is higher. Effective treatments for hepatitis B exist, but a delivery gap exits. As with HIV—AIDS, partners are required to assist countries to implement operational plans to define their hepatitis B treatment programs. There has to be a fundamental acceptance that viral hepatitis, which can be treated, leads to high numbers of deaths annually—despite the advent of HBV vaccination and effective treatments.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212–9.

    Article  CAS  PubMed  Google Scholar 

  2. Wallace MC, Preen D, Jeffrey GP, Adams LA. The evolving epidemiology of hepatocellular carcinoma: a global perspective. Expert Rev Gastroenterol Hepatol. 2015:1–15.

  3. Sherman M, Kim RW, Dziura J. Risk scores for hepatocellular carcinoma in chronic hepatitis B. Hepatology (Baltimore, Md). 2015. Important analysis of risk scores in hepatocellular carcinoma.

  4. WHO guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. 2015. New WHO guidelines that determine management policy for policy makers worldwide, in order to reduce the morbidity from chronic hepatitis B.

  5. Kay A, Zoulim F. Hepatitis B virus genetic variability and evolution. Virus Res. 2007;127(2):164–76.

    Article  CAS  PubMed  Google Scholar 

  6. Kurbanov F, Tanaka Y, Mizokami M. Geographical and genetic diversity of the human hepatitis B virus. Hepatol Res : Off J Jap Soc Hepatol. 2010;40(1):14–30.

    Article  Google Scholar 

  7. Hadziyannis SJ. Natural history of chronic hepatitis B in Euro-Mediterranean and African countries. J Hepatol. 2011;55(1):183–91.

    Article  PubMed  Google Scholar 

  8. McMahon BJ. Natural history of chronic hepatitis B. Clin Liver Dis. 2010;14(3):381–96.

    Article  PubMed  Google Scholar 

  9. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology (Baltimore, Md). 2009;50(3):661–2.

    Article  Google Scholar 

  10. McMahon BJ. Hepatitis B, surface antigen (HBsAg): a 40-year-old hepatitis B virus seromarker gets new life. Gastroenterology. 2010;139(2):380–2.

    Article  PubMed  Google Scholar 

  11. Martinot-Peignoux M, Lapalus M, Asselah T, Marcellin P. The role of HBsAg quantification for monitoring natural history and treatment outcome. Liver Int. 2013;33 Suppl 1:125–32. doi:10.1111/liv.12075.:125[-‐]32.

    Article  CAS  PubMed  Google Scholar 

  12. McMahon BJ. Chronic hepatitis B virus infection. Med Clin North Am. 2014;98(1):39–54.

    Article  PubMed  Google Scholar 

  13. Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012;142(6):1293–302. e4.

    Article  PubMed  Google Scholar 

  14. Lok ASF, McMahon BJ. Chronic hepatitis B: update 2009. Alexandria, Virginia: 2009 2009. Report No.

  15. Iloeje UH, Yang HI, Chen CJ. Natural history of chronic hepatitis B: what exactly has REVEAL revealed? Liver Int : offi J Int Assoc Stud Liver. 2012;32(9):1333–41.

    Article  Google Scholar 

  16. Basar O, Yimaz B, Ekiz F, Ginis Z, Altinbas A, Aktas B, et al. Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B and comparison with post-antiviral treatment results. Clin Research Hepatol Gastroenterol. 2013;37(2):152–8.

    Article  CAS  Google Scholar 

  17. Erdogan S, Dogan HO, Sezer S, Uysal S, Ozhamam E, Kayacetin S, et al. The diagnostic value of non-invasive tests for the evaluation of liver fibrosis in chronic hepatitis B patients. Scandinavian J Clin Lab Investig. 2013.

  18. Chen J, Liu C, Chen H, Liu Q, Yang B, Ou Q. Study on noninvasive laboratory tests for fibrosis in chronic HBV infection and their evaluation. J Clin Lab Anal. 2013;27(1):5–11.

    Article  CAS  PubMed  Google Scholar 

  19. Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology (Baltimore, Md). 2015;61(1):292–302.

    Article  Google Scholar 

  20. Teshale E, Lu M, Rupp LB, Holmberg SD, Moorman AC, Spradling P, et al. APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS). J Viral Hepat. 2014;21(12):917–20.

    Article  CAS  PubMed  Google Scholar 

  21. Organization WH. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. 2015.

  22. Seo YS, Kim MY, Kim SU, Hyun BS, Jang JY, Lee JW, et al. Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: a multicentre, retrospective study. Liver Int : Off J Int Assoc Stud Liver. 2015.

  23. Afdhal NH, Bacon BR, Patel K, Lawitz EJ, Gordon SC, Nelson DR. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clini Gastroenterol Hepatol : Off Clin Practice J Am Gastroenterol Assoc. 2015;13((4):772–9. e1-3.

    Article  Google Scholar 

  24. Piscaglia F, Salvatore V, Di Donato R, D’Onofrio M, Gualandi S, Gallotti A, et al. Accuracy of VirtualTouch Acoustic Radiation Force Impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med. 2011;32(2):167–75.

    Article  CAS  PubMed  Google Scholar 

  25. Friedrich-Rust M, Buggisch P, de Knegt RJ, Dries V, Shi Y, Matschenz K, et al. Acoustic radiation force impulse imaging for non-invasive assessment of liver fibrosis in chronic hepatitis B. J Viral Hepat. 2013;20(4):240–7.

    Article  CAS  PubMed  Google Scholar 

  26. Zeng J, Liu GJ, Huang ZP, Zheng J, Wu T, Zheng RQ, et al. Diagnostic accuracy of two-dimensional shear wave elastography for the non-invasive staging of hepatic fibrosis in chronic hepatitis B: a cohort study with internal validation. Eur Radiol. 2014;24(10):2572–81.

    Article  PubMed  Google Scholar 

  27. Bottero J, Boyd A, Lemoine M, Carrat F, Gozlan J, Collignon A, et al. Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region. PLoS One. 2014;9(3):e92266.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008;2(3):263–83.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Chou R, Dana T, Bougatsos C, Blazina I, Khangura J, Zakher B. Screening for hepatitis B virus infection in adolescents and adults: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2014;161(1):31–45.

    Article  PubMed  Google Scholar 

  30. Marcellin P, Gane E, Buti M, Afdhal N, Sievert W, Jacobson IM, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet. 2013;381(9865):468–75.

    Article  CAS  PubMed  Google Scholar 

  31. Chang TT, Liaw YF, Wu SS, Schiff E, Han K, Lai CL. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology (Baltimore, Md). 2010;52(3):886–93.

    Article  CAS  Google Scholar 

  32. Xi ZF, Xia Q. Recent advances in prevention of hepatitis B recurrence after liver transplantation. World J Gastroenterol : WJG. 2015;21(3):829–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Roche B, Samuel D. Prevention of hepatitis B virus reinfection in liver transplant recipients. Intervirology. 2014;57(3–4):196–201.

    Article  CAS  PubMed  Google Scholar 

  34. Roche B, Samuel D. Treatment of patients with HBV-related decompensated cirrhosis and liver transplanted patients. Clin Liver Dis. 2013;17(3):451–73.

    Article  PubMed  Google Scholar 

  35. Cholongitas E, Papatheodoridis GV. High genetic barrier nucleos(t)ide analogue(s) for prophylaxis from hepatitis B virus recurrence after liver transplantation: a systematic review. Am J Transplant : Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13(2):353–62.

    Article  CAS  Google Scholar 

  36. Jonas MM, Block JM, Haber BA, Karpen SJ, London WT, Murray KF. Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options. Hepatology (Baltimore, Md). 2010;52(6):2192–205.

    Article  Google Scholar 

  37. de Vries-Sluijs TE, Reijnders JG, Hansen BE, Zaaijer HL, Prins JM, Pas SD, et al. Long-term therapy with tenofovir is effective for patients co-infected with human immunodeficiency virus and hepatitis B virus. Gastroenterology. 2010;139(6):1934–41.

    Article  PubMed  Google Scholar 

  38. Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology (Baltimore, Md). 2015.

  39. Greenup AJ, Tan PK, Nguyen V, Glass A, Davison S, Chatterjee U, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus. J Hepatol. 2014;61(3):502–7.

    Article  CAS  PubMed  Google Scholar 

  40. Rockstroh JK, Hardy WD. Antiretroviral therapy in coinfected patients: viral hepatitis and tuberculosis. Curr Opin HIV AIDS. 2006;1(5):442–8.

    Article  PubMed  Google Scholar 

  41. Wyatt C, Baeten JM. Tenofovir alafenamide for HIV infection: is less more? The Lancet. 2015.

  42. Andersson KL, Chung RT. Monitoring during and after antiviral therapy for hepatitis B. Hepatology. 2009;49(5 Suppl):S166–S73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hass HG, Bock T, Nehls O, Kaiser S. Rapid HBV DNA decrease (week 12) is an important prognostic factor for first-line treatment with adefovir dipivoxil for chronic hepatitis B. J Gastroenterol. 2009;44(8):871–7.

    Article  CAS  PubMed  Google Scholar 

  44. Tohme RA, Bulkow L, Homan CE, Negus S, McMahon BJ. Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001–2010. J Clin Virol. 2013;58(2):396–400.

    Article  PubMed  Google Scholar 

  45. Papatheodoridis GV, Manolakopoulos S, Liaw YF, Lok A. Follow-up and indications for liver biopsy in HBeAg-negative chronic hepatitis B virus infection with persistently normal ALT: a systematic review. J Hepatol. 2012.

  46. Fernandez-Fernandez B, Montoya-Ferrer A, Sanz AB, Sanchez-Nino MD, Izquierdo MC, Poveda J, et al. Tenofovir nephrotoxicity: 2011 update. AIDS Res Treat. 2011;2011:354908.

    PubMed  PubMed Central  Google Scholar 

  47. Farmer PE. Shattuck lecture. Chronic infectious disease and the future of health care delivery. N Engl J Med. 2013;369(25):2424–36.

    Article  CAS  PubMed  Google Scholar 

  48. Dusheiko G. Interruption of mother-to-infant transmission of hepatitis B: time to include selective antiviral prophylaxis? Lancet. 2012;379(9830):2019–21.

    Article  PubMed  Google Scholar 

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The authors declare that they have no competing interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Hepatology Unit, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy

    Shirin Demma

  2. UCL Institute of Liver and Digestive Health, Royal Free NHS Foundation Trust, London, UK

    Shirin Demma, Emmanouil Tsochatzis & Geoffrey Dusheiko

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  1. Shirin Demma
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  2. Emmanouil Tsochatzis
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  3. Geoffrey Dusheiko
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Correspondence to Geoffrey Dusheiko.

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This article is part of the Topical Collection on Hepatitis B

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Demma, S., Tsochatzis, E. & Dusheiko, G. Expansion of Access to HBV Treatment. Curr Hepatology Rep 14, 195–202 (2015). https://doi.org/10.1007/s11901-015-0272-8

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  • DOI: https://doi.org/10.1007/s11901-015-0272-8

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