Treatment and Monitoring Recommendations for Asian-Americans Published

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Treatment and Monitoring Recommendations for Asian-Americans Published

A group of Asian-American experts have recommended a set of guidelines for monitoring and treatment of Asian-American patients with hepatitis B in the September publication of the journal of Digestive Diseases and Sciences.

Asian-Americans are at high risk of hepatitis B due to its prevalence in Asia and there has been poor screening and immunization among immigrants and their descendants. Currently, experts estimate between 7% to 16% of Asian-Americans have chronic hepatitis B and test positive for the hepatitis B surface antigen (HBsAg). The experts recommend that patients at risk for liver damage from the infection should be treated with antivirals—either entecavir (Baraclude) and tenofovir (Viread). The primary goal of treatment is to suppress viral replication, keep viral load (HBV DNA) as low as possible, and reverse any existing fibrosis. Antiviral treatment has also been found to greatly reduce the risk of cirrhosis and liver cancer.

Patients who are candidates for treatment include those with high viral load and elevated alanine aminotransferase (ALT) levels, which indicate liver cell damage.

Other indicators for treatment include having testing positive for the hepatitis B e antigen (HBeAg-positive) along with high viral loads, and testing negative for HBeAg if the patient’s HBV DNA levels exceed 10,000  copies/mL (or 2,000 IU/mL).
Also benefitting from treatment are HBeAg-negative patients with HBV DNA greater than 10,000 copies/mL and normal ALT levels, but who have either serum albumin less than or equal to 3.5 g/dL or platelet count less than or equal to 130,000 mm, or basal core promoter mutations.
Anyone with close relatives who have had liver cancer should also be offered treatment.
Patients with cirrhosis and detectable HBV DNA must receive antiviral therapy.
Antiviral treatment should also be offered to pregnant women with high viral load, to prevent mother-to-child infection, and to those requiring immunosuppressive therapy for cancer or other diseases. Drugs or chemotherapy that suppresses the immune system enables the infection to rebound.
In HBsAg-positive patients with risk factors, lifelong surveillance for liver cancer with alpha-fetoprotein testing and abdominal ultrasound examination at six-month intervals is required.