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Treatment Guidelines Exclude Some Hepatitis B Patients

Can be improved by including additional features

MONDAY, Sept. 29 (HealthDay News) -- Current guidelines for the treatment of chronic hepatitis B virus (HBV) infection exclude many patients who develop serious liver-related complications, although this can be improved by including additional clinical and viral features, according to a report published in the October issue of Hepatology.

Myron John Tong, M.D., Ph.D., from Huntington Medical Research Institutes in Pasadena, Calif., and colleagues retrospectively applied four published guidelines for the treatment of HBV to 369 patients positive for hepatitis B surface antigen (HBsAg), of whom 30 developed hepatocellular carcinoma (HCC) and 37 died of non-HCC liver-related causes over a mean follow-up of 84 months. They note that current treatment guidelines are based on HBeAg status, levels of HBV DNA, and serum alanine aminotransferase levels.

The researchers found that only 20 percent to 60 percent of patients who developed HCC, and 27 percent to 70 percent of patients who died of non-HCC liver-related causes would have been candidates for antiviral treatment. This could be improved up to 100 percent by adding baseline serum albumin levels of 3.5 mg/dL or less, platelet counts of 130,000 mm3 or less, and basal core promoter T1762/A1764 mutants and precore A1896 mutants to the current treatment guidelines.

"This retrospective analysis showed that the current treatment guidelines for chronic hepatitis B excluded patients who developed serious liver-related complications," Tong and colleagues conclude.

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