American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
After a period of treatment consolidation , consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. If antiviral therapy is stopped, monitor the patient every 3 months for a minimum of 1 year for recurrent viremia, ALT flares, seroreversion, and clinical decompensation.
Adults with HBeAg-negative immune-active chronic HBV infection
Advances In New Drugs To For Curing Hepatitis B And Hepatitis D Announced At Ilc 2021
For Immediate Release
Advances in new drugs to for curing Hepatitis B and Hepatitis D announced at ILC 2021
Thursday 24 June 2021 Leading hepatology researchers announced important new developments in hepatitis research at the International Liver Congress 2021 today. This includes new data on antivirals to cure Hepatitis B and Hepatitis D and the application of infusion chemotherapy with P-1 inhibitors to treat liver cancer.
Other announcements included a review of the impact of the COVID-19 pandemic on efforts to eliminate Hepatitis C in the USA and some encouraging data from a trial of a new liver dialysis device to treat acute on chronic liver failure .
Scientists and advocates have long argued that if we are realistically going to eliminate Hepatitis B, then we will need a functional cure, said Philip Newsome, Secretary General of EASL and Professor of Experimental Hepatology and Director of the Centre for Liver Research at the University of Birmingham in the UK. The results from the trial of RNAi therapeutic drug VIR-2218 are an encouraging example that a cure is possible sooner than later with potential real-world implications for the 300 million people living with the disease.
Todays official press conference highlighted five studies covering treatment and cure research for hepatitis and acute on chronic liver failure selected from over 1500 abstracts being presented at ILC 2021.
Impact of COVID-19 on eliminating Hepatitis in the U.S.
What Is Hepatitis B
Hepatitis B is an infection of your liver. Itâs caused by a virus. There is a vaccine that protects against it. For some people, hepatitis B is mild and lasts a short time. These âacuteâ cases donât always need treatment. But it can become chronic. If that happens, it can cause scarring of the organ, liver failure, and cancer, and it even can be life-threatening.
Itâs spread when people come in contact with the blood, open sores, or body fluids of someone who has the hepatitis B virus.
It’s serious, but if you get the disease as an adult, it shouldnât last a long time. Your body fights it off within a few months, and youâre immune for the rest of your life. That means you can’t get it again. But if you get it at birth, itâ unlikely to go away.
âHepatitisâ means inflammation of the liver. There are other types of hepatitis. Those caused by viruses also include hepatitis A and hepatitis C.
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Clearing Acute Hepatitis B
Some studies suggest that up to 95% of adults with acute HBV infection will spontaneously clear the virus, usually within six months, with no lasting repercussions.
Chronic hepatitis B occurs when the immune system does not clear the virus. Around one of every 20 people acutely infected with HBV will progress to this persistent stage of infection.
Chronic hepatitis B is a slowly progressive disease in which ongoing inflammation causes the gradual scarring of the liver. This can lead to cirrhosis and hepatocellular carcinoma .
However, the course of chronic HBV infection is not set. Some people may progress faster than others, while others may never develop overt symptoms.
- The risk of cirrhosis in people with chronic hepatitis B is approximately 10% to 20% over 20 years, increasing to 40% after 30 years.
- The risk of hepatocellular carcinoma increases by 2% and 3% per year in people with HBV and cirrhosis. People without cirrhosis can also get it, but the annual risk drops to around 0.02%.
Neutralization Of Hepatitis B Virus With Vaccine
The hepatitis B vaccine is recognised as the most effective approach in reducing hepatitis-B-related morbidity vaccine-escape mutations are however capable of infecting vaccinated individuals. In this work, authors aim to establish a hepatitis B vaccine candidate, which they assess in rhesus macaques in terms of efficacy and safety.
11 July 2022 | Open Access
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Logistic Regression Analysis Of Week 48 Hbsag Clearance In All Patients
To determine the relationship between baseline data and 48-week HBsAg clearance, logistic regression analysis was performed . Baseline age and HBsAg were negative factors for week 48 HBsAg clearance, while gender, HBV-DNA negative duration, baseline ALT, AST, TB, ALB, HBeAg seroconversion, combined ETV or TDF or TAF, interferon alone, interferon-experienced were not associated factor for week 48 HBsAg clearance.
Table 4 Logistic regression analysis of week 48 HBsAg clearance in all patients.
Based on the results of logistic regression, we constructed a risk score logit that predicts whether HBsAg clearance could be achieved:
Also, ROC curves were generated to assess the accuracy of P in predicting HBsAg clearance at 48 weeks . The area under the curve was 0.814, 95% CI , indicating a good accuracy. The best cut-off value for the P value was 0.401 and the corresponding Youden index, sensitivity and specificity were 0.483, 0.692, and 0.791. When the sensitivity was 95%, the P value was 0.598. And when the specificity was 95%, the P value was 0.103.
Hepatitis B Cure Sought With Help Of Animal Research
Oregon Health & Science Universitys nonhuman primate model of hepatitis B is about to help biotechnology and pharmaceutical companies develop new treatments that seek to cure the millions of people living with chronic hepatitis B.
While it may not grab much of the publics attention, there are more people living on this planet with hepatitis B than HIV, said Benjamin Burwitz, Ph.D., an assistant professor at the OHSU Vaccine and Gene Therapy Institute and an affiliate assistant professor at the OHSU Oregon National Primate Research Center, who led the models development. I hope our rhesus macaque model will lead to new treatments that can alleviate those suffering from chronic Hepatitis B.
Even though a vaccine has been available since the 1980s, about 2 billion people worldwide have been infected with the hepatitis B virus. The vaccine doesnt work for about 10% of those who receive it, and it requires cold storage, which makes bringing the vaccine to remote areas challenging.
Those who are infected as children usually develop chronic hepatitis B, which can cause fatigue, nausea, jaundice, cirrhosis and liver cancer, and can even make a liver transplant necessary. About 257 million people worldwide and 862,000 Americans are living with chronic hepatitis B.
Burwitz is working with companies that are interested in using OHSUs model to evaluate new drugs theyre developing to treat hepatitis B.
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Predict Week 48 Hbsag Clearance With Indicators At The Early Stage Of Treatment
To determine the relationship between early stage indicators and week 48 HBsAg clearance, logistics regression analysis was performed . The results showed that Week 12 HBsAg was a negatively correlated factor for week 48 HBsAg clearance, while Week 12 HBsAg change from baseline, week 12 ALT, and Week 12 ALT elevation from baseline were not the associated factors for week 48 HBsAg clearance.
Table 6 Predict week 48 HBsAg clearance with week 12 indicators.
ROC curves were produced to assess the accuracy of week 12 HBsAg for predicting week 48 HBsAg clearance . The area under the curve was 0.888, 95% CI , depicting a good accuracy. The optimal cut-off value of week 12 HBsAg was 34.99 IU/ml, corresponding Youden index, sensitivity and specificity at 0.689, 0.843, and 0.846. When the sensitivity was set at 95%, the HBsAg value was at 4.715 IU/ml. Also, the HBsAg value was 198.6 IU/ml, when the specificity was 95%. These suggested a good accuracy of week 12 HBsAg for predicting week 48 HBsAg clearance.
European Commission And Thervacb Join Forces
The role of viral hepatitis as a public health threat has long been underestimated. Only very recently, the United Nations in their 2030 Agenda for Sustainable Development called for international action to combat viral hepatitis and reduce the disease burden. The major killer is the hepatitis B virus causing liver cirrhosis and liver cancer. Worldwide 880,000 humans die each year from the consequences of an HBV infection.
A prophylactic vaccine is available to prevent HBV infection, but more than 3% of the worlds population are chronically infected and do not profit from that vaccine anymore. For those suffering from chronic hepatitis B, until today no curative treatment option exists.
The European Commission therefore selected the project TherVacB led by Helmholtz Zentrum München for a five-year funding within the Horizon 2020 program. A consortium of leading virologists, immunologists and physicians specialized in treating viral hepatitis, will use a newly designed therapeutic vaccine, TherVacB, as an immunotherapy to cure HBV. TherVacB will be evaluated in a three-year clinical trial starting in 2022 conducted in Europe and in Africa. Integration of a partner site in Tanzania shall help building local capacities for diagnosing and treating hepatitis B and support an important goal of the consortium to raise awareness for hepatitis B.
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The Future Of Treatment
Chairman of the Scientific Advisory Council for the annual International Hepatitis B Virus Meeting and the Incoming Chair of the International Coalition to Eliminate HBV, Dr Tavis works on the front line of researching new developments in HBV treatments.
Dr Tavis says the cure to HBV is coming. The feeling within the scientific community is that major improvements will happen somewhere in the next five to 10 years it isnt going to be one optimal combination at first.
New Investment Takes Hepatitis B Research One Step Closer To Finding A Cure
Melbourne scientists have been awarded $1.7 million over the next five years, to advance world-first research into a cure for hepatitis B virus infection thanks to a grant from the mRNA Victoria Activation Program.
Chronic hepatitis B disease, caused by the hepatitis B virus infection, remains a significant worldwide public health issue, with an estimated 296 million people chronically infected including over 226,000 Australians.
There is no cure for chronic hepatitis B disease. Current Hepatitis B treatment can reduce the progression of liver disease by stopping the virus from replicating, however treatment is lifelong and does not fully eliminate the risk of liver cancer. New approaches to treat and cure HBV infection are needed.
The Royal Melbourne Hospitals Dr Margaret Littlejohn is a Senior Medical Scientist in the Victorian Infectious Diseases Reference Laboratory at the Doherty Institute. She is the Chief Investigator of a research project looking to develop a new RNA-based therapy for chronic hepatitis B.
Chronic hepatitis B hasnt been cured so far in part because current therapies have failed to destroy the reservoir of viral DNA, where the virus hides in the cells of the liver, Dr Littlejohn explains.
Using CRISPR technology, a highly significant new technique that allows scientists to modify or destroy targeted DNA sequences, Dr Littlejohns team has already made some promising discoveries, in collaboration with scientists at Peter MacCallum Cancer Centre.
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Is Hepatitis B Curable
Theres no cure for hepatitis B. The good news is it usually goes away by itself in 4 to 8 weeks. More than 9 out of 10 adults who get hepatitis B totally recover.
However, about 1 in 20 people who get hepatitis B as adults become carriers, which means they have a chronic hepatitis B infection. Carriers are more likely to pass hepatitis B to other people. Most carriers are contagious meaning they can spread hepatitis B for the rest of their lives.
Hepatitis B infections that last a long time may lead to serious liver diseases like cirrhosis and liver cancer. About 1 in 5 people with chronic hepatitis B die from it. There are medicines that can help treat chronic hepatitis B infections.
Most babies who get hepatitis B during birth develop chronic infection, unless they get treated right away. But treatments are almost always effective if your baby gets them quickly. Thats why its important for pregnant people to get tested for hepatitis B.
New Immunotherapy ‘highly Effective’ Against Hepatitis B
- University College London
- Scientists have identified a new immunotherapy to combat the hepatitis B virus , the most common cause of liver cancer in the world.
Scientists at UCL have identified a new immunotherapy to combat the hepatitis B virus , the most common cause of liver cancer in the world.
Each year, globally, chronic HBV causes an estimated 880,000 deaths from liver cirrhosis and hepatocellular carcinoma/liver cancer .
The pioneering study used immune cells isolated directly from patient liver and tumour tissue, to show that targeting acyl-CoA:cholesterol acyltransferase , an enzyme that helps to manage cholesterol levels in cells*, was highly effective at boosting immune responses.
Published in Nature Communications, the findings show that blocking the activity of ACAT with ACAT inhibitors boosts the specific immune cells that can fight both the virus and associated cancerous tumours, demonstrating its effectiveness as an immunotherapy. Inhibiting ACAT was also found to impede HBV’s own replication, thereby also acting as a direct antiviral. ACAT inhibitors such as avasimibe, taken orally, have previously been shown to be well-tolerated as cholesterol-lowering drugs in humans.
Explaining the study, lead author Professor Mala Maini , said: “Chronic hepatitis B virus infection is a major global health problem and the most common cause of liver cancer in the world.
Grant funding came from the Wellcome Trust and Cancer Research UK.
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With The Momentum Growing Around Hepatitis B Drug Discovery Research We Are Closer Than Ever To A Cure
From the Spring 2016 B Informed Newsletter
With the momentum growing around hepatitis B drug discovery research, how far are we from a cure?
Closer than ever, according to Timothy Block, PhD, president and co-founder of the Hepatitis B Foundation and its research arm, the Baruch S. Blumberg Institute. He points out that hepatitis C, initially thought to be incurable, can now be cured with new combination treatments.
Hepatitis B is in a similar position, Block believes. And the need for a cure has never been greater, with over 240 million people living with chronic hepatitis B infection worldwide, resulting in 1 million deaths per year from related liver failure and liver cancer.
Treatments are available, explains Block, but we have become a little too comfortable with the seven medications that are currently approved for use. While these drugs are effective, the interferons have many side effects and the oral antivirals require lifelong use. Moreover, they work in only about half of the infected population, and reduce the rate of death due to liver disease by only about 40 to 70 percent.
For those who benefit from treatment, the antiviral drugs prove that medications can be effective. However, there are millions who do not benefit and are still left vulnerable. We should not accept that a significant number of people will still die from hepatitis B-related complications despite taking the current drugs, Block declares.
What would a cure look like?
How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
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Who Should Get The Hepatitis B Vaccine
All newborn babies should get vaccinated. You should also get the shot if you:
- Come in contact with infected blood or body fluids of friends or family members
- Use needles to take recreational drugs
- Have sex with more than one person
- Are a health care worker
- Work in a day-care center, school, or jail
Hepatitis B And Pregnancy
The American College of Obstetricians and Gynecologists , the US Preventive Services Task Force , and the World Health Organization recommend routine prenatal screening for hepatitis B surface antigen in all pregnant womenduring every pregnancyregardless of previous test results or vaccinations. Pregnant women at risk for hepatitis B infections should be specifically targeted for vaccination. The risk of transmission of hepatitis B associated with amniocentesis is low. WHO further recommends all pregnant women undergo testing at least once for HIV and syphilis in addition to that for HBsAg and as early as possible in the pregnancy.
It is recommended that all infants receive their first dose of hepatitis B vaccine as soon as possible after birth , followed by two or three doses to complete the primary series.
To prevent maternal-fetal HBV transmission, a conditional WHO recommendation is that HBsAg-positive gravida who have an HBV DNA 5.3 log10 IU/mL receive tenofovir prophylaxis beginning the 28th week of pregnancy until at least birth. This is in addition to the three-dose hepatitis B vaccination in all infants, including a timely birth dose. When antenatal HBV DNA testing is not available, HBeAg testing can be used as an alternative study to determine eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.
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