Abstract

Background/Aims: Guidelines for the treatment of chronic hepatitis B have been recently updated in the 2009 EASL consensus statement, the 2008 United States Panel, the 2008 Asian-Pacific consensus statement, and the 2009 AASLD practice guidelines. We sought to determine whether these guidelines identified patients who developed hepatocellular carcinoma (HCC) or who died of non-HCC liver-related deaths for anti-viral therapy.

Methods: The criteria described in the new treatment guidelines were matched to the database of 369 HBsAg-positive patients in whom 30 developed HCC and 37 died of non-HCC liver-related deaths during a mean follow-up of 84 months.

Results: Using criteria for anti-viral therapy as stated by the four current guidelines, 19-30% of patients who died of non-HCC liver-related complications and 23-53% of patients who developed HCC would have been excluded for anti-viral therapy. If baseline serum albumin levels of ?3.5g/dl or platelet counts of ?130,000mm(3) were included into the treatment criteria, then 85% to 94% of patients who developed liver-related complications would have been recommended for anti-viral therapy. Also, the addition of precore A1896 mutants and basal core promoter T1762/A1764 mutants would have identified 98.5% to 100% of these patients.

Conclusion: The updated treatment guidelines for hepatitis B still excluded patients who developed serious liver-related complications. The inclusion of baseline serum albumin and platelet counts to current criteria would have identified a majority of these patients for anti-viral therapy. These tests should be included into hepatitis B treatment strategies.