简化慢性乙型肝炎的治疗标准：减少消除障碍

StephenW

简化慢性乙型肝炎的治疗标准：减少消除障碍
临床传染病 2022 年 5 月 20 日 Robert J. Wong, M.D., M.S.1,2, Harvey W. Kaufman, M.D.3, Justin K. Niles, M.A.3, Hema Kapoor,3 M.D.3, Robert G. Gish, M.D.4
抽象的
背景

早期、持续的乙型肝炎病毒 (HBV) DNA 抑制可降低肝细胞癌的长期风险。慢性乙型肝炎 (CHB) 治疗标准很复杂。简化标准将改善与治疗的及时联系。我们评估了美国 CHB 患者的治疗资格模式，并建议逐步简化 CHB 治疗标准。
方法

使用 2016-2020 年 Quest Diagnostics 数据，使用美国肝病研究协会 (AASLD)、欧洲肝病协会评估 CHB 患者的治疗资格（两次阳性 HBV 检测 [HBsAg、HBeAg 或 HBV DNA] ≥ 6 个月）肝脏研究 (EASL)、亚太肝脏研究协会 (APASL) 和亚裔美国人治疗算法 (AATA) 标准。
结果

在 84,916 名 CHB 患者中，分别有 6.7%、6.2%、5.8% 和 16.4% 的患者符合 AASLD、EASL、APASL 和 AATA 标准。根据 AASLD、EASL、APASL 和 AATA，在不适合治疗的 CHB 患者中，显着纤维化（AST 血小板比率指数>0.5）的比例分别为 10.4%、10.4%、10.8% 和 7.7%。在拟议的治疗简化中，符合治疗条件的 CHB 患者比例从第 1 步（HBV DNA >20,000 IU/mL，ALT 升高）的 10.3% 增加到第 2 步（HBV >2,000 IU/mL，ALT 升高）的 14.1%，第 3 步（HBV DNA >2,000 IU/mL，任何 ALT）为 33.5%，第 4 步为 87.2%（可检测 HBV DNA，任何 ALT）。
结论

大部分不符合既定治疗标准的慢性乙型肝炎患者有明显的纤维化。简化治疗所有可检测到 HBV DNA 患者的标准将降低评估治疗资格、提高治疗率和消除 HBV 进展的复杂性和异质性。
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StephenW

Simplifying Treatment Criteria in Chronic Hepatitis B: Reducing Barriers to Elimination
Clinical Infectious Diseases 20 May 2022 Robert J. Wong, M.D., M.S.1,2, Harvey W. Kaufman, M.D.3, Justin K. Niles, M.A.3, Hema Kapoor,3 M.D.3, Robert G. Gish, M.D.4
Abstract
Background

Early, sustained hepatitis B virus (HBV) DNA suppression reduces long-term risks of hepatocellular carcinoma. Chronic hepatitis B (CHB) treatment criteria are complex. Simplifying criteria will improve timely linkage-to-therapy. We evaluated treatment eligibility patterns among U.S. CHB patients and propose stepwise simplification of CHB treatment criteria.
Methods

Using 2016-2020 Quest Diagnostics data, treatment eligibility among CHB patients (two positive HBV tests [HBsAg, HBeAg, or HBV DNA] ≥6 months apart) was evaluated using American Association for the Study of Liver Disease (AASLD), European Association for Study of the Liver (EASL), Asian Pacific Association for Study of the Liver (APASL), and Asian American Treatment Algorithm (AATA) criteria.
Results

Among 84,916 CHB patients, 6.7%, 6.2%, 5.8%, and 16.4% met AASLD, EASL, APASL, and AATA criteria, respectively. Among treatment-ineligible CHB patients, proportion with significant fibrosis (AST platelet ratio index >0.5) were 10.4%, 10.4%, 10.8%, and 7.7% based on AASLD, EASL, APASL, and AATA, respectively. In the proposed treatment simplification, proportion of CHB patients eligible for therapy increased from 10.3% for step 1 (HBV DNA >20,000 IU/mL, elevated ALT) to 14.1% for step 2 (HBV >2,000 IU/mL, elevated ALT), 33.5% for step 3 (HBV DNA >2,000 IU/mL, any ALT), and 87.2% for step 4 (detectable HBV DNA, any ALT).
Conclusions

A large proportion of CHB patients not meeting established treatment criteria have significant fibrosis. Simplifying criteria to treat all patients with detectable HBV DNA will reduce complexity and heterogeneity in assessing treatment eligibility, improving treatment rates and progress towards HBV elimination.
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