Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.
Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.
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DOI：
10.1002/cld.728
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发表时间：
2018-04-01
期刊：
影响因子：
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通讯作者：
Wong, John B
中科院分区：
文献类型：
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作者：
Terrault, Norah A;Lok, Anna S F;Wong, John B
本AASLD 2018年B型肝炎指南旨在补充AASLD 2016年慢性B型肝炎治疗实践指南（1），并更新2009年以来的既往B型肝炎病毒（HBV）指南。2018年更新的慢性B型肝炎（CH B）指南包括（1）自2016年HBV指南以来的治疗更新（特别是使用替诺福韦艾拉酚胺）和指导（2）筛查，咨询和预防;（3）专门的病毒学和血清学检测;（4）监测未经治疗的患者;和（5）特殊人群的B型肝炎治疗，包括病毒合并感染者、急性B型肝炎、免疫抑制治疗接受者和移植接受者。AASLD 2018年B型肝炎指南为B型肝炎患者的筛查、预防、诊断和临床管理提供了数据支持的方法。它不同于2016年发布的AASLD指南，该指南进行了系统性审查，并使用多学科专家小组对证据的质量（水平）和每个建议的强度进行评级，使用建议评估，发展和评价系统来支持指南建议。(1-4)相比之下，本指南文件是由专家小组协商一致制定的，没有进行正式的系统审查，也没有使用建议评估、制定和评价系统的分级。2018年指南基于以下内容：（1）对已发表文献的正式审查和分析;（2）世界卫生组织关于CHB预防，护理和治疗的指南（5）;以及（3）作者在急性B肝炎和CHB方面的经验。本指南旨在供医疗保健提供者使用，确定了慢性乙型肝炎患者诊断、治疗和预防护理方面的首选方法。与临床实践指南一样，它提供了优化治疗的一般指导。缩略语：AFP，甲胎蛋白; ALT，丙氨酸转氨酶;抗HBc，B肝炎核心抗原抗体;抗HBe，B肝炎e抗原抗体;抗HBs，B肝炎表面抗原抗体; ARVT，抗逆转录病毒治疗; AST，天冬氨酸转氨酶; cccDNA，共价闭合环状DNA; CHB，慢性B肝炎; DAA，直接作用型抗病毒药物; HBeAg，B型肝炎e抗原; HBIG，B型肝炎免疫球蛋白; HBsAg，B型肝炎表面抗原; HBV，B型肝炎病毒; HCC，肝细胞癌; HCV，丙型肝炎病毒; HCW，卫生保健工作者; HDV，丁型肝炎病毒; HIV，人类免疫缺陷病毒; IFN，干扰素; IFN-α，干扰素-α; NA，核苷类似物; peg-IFN，聚乙二醇干扰素; peg-IFN-a，聚乙二醇化干扰素-α; qHBsAg，定量B型肝炎表面抗原; TAF，替诺福韦艾拉酚胺; TDF，富马酸替诺福韦二异丙酯; ULN，正常值上限; US，超声检查。
This AASLD 2018 Hepatitis B Guidance is intended to complement the AASLD 2016 Practice Guidelines for Treatment of Chronic Hepatitis B (1) and update the previous hepatitis B virus (HBV) guidelines from 2009. The 2018 updated guidance on chronic hepatitis B (CHB) includes (1) updates on treatment since the 2016 HBV guidelines (notably the use of tenofovir alafenamide) and guidance on (2) screening, counseling, and prevention;(3) specialized virological and serological tests;(4) monitoring of untreated patients; and (5) treatment of hepatitis B in special populations, including persons with viral coinfections, acute hepatitis B, recipients of immunosuppressive therapy, and transplant recipients. The AASLD 2018 Hepatitis B Guidance provides a data-supported approach to screening, prevention, diagnosis, and clinical management of patients with hepatitis B. It differs from the published 2016 AASLD guidelines, which conducted systematic reviews and used a multidisciplinary panel of experts to rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations Assessment, Development and Evaluation system in support of guideline recommendations.(1-4) In contrast, this guidance document was developed by consensus of an expert panel, without formal systematic review or use of the Grading of Recommendations Assessment, Development, and Evaluation system. The 2018 guidance is based upon the following:(1) formal review and analysis of published literature on the topics;(2) World Health Organization guidance on prevention, care, and treatment of CHB (5); and (3) the authors’ experience in acute hepatitis B and CHB. Intended for use by health care providers, this guidance identifies preferred approaches to the diagnostic, therapeutic, and preventive aspects of care for patients with CHB. As with clinical practice guidelines, it provides general guidance to optimize the care of theAbbreviations: AFP, alpha-fetoprotein; ALT, alanine aminotransferase; anti-HBc, antibody to hepatitis B core antigen; anti-HBe, antibody to hepatitis B e antigen; anti-HBs, antibody to hepatitis B surface antigen; ARVT, antiretroviral therapy; AST, aspartate aminotransferase; cccDNA, covalently closed circular DNA; CHB, chronic hepatitis B; DAA, direct-acting antiviral; HBeAg, hepatitis B e antigen; HBIG, hepatitis B immune globulin; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HCWs, health care workers; HDV, hepatitis D virus; HIV, human immunodeficiency virus; IFN, interferon; IFN-a, interferon-alfa; NA, nucleos (t) ide analogue; peg-IFN, peginterferon; peg-IFN-a, pegylated interferon-alfa; qHBsAg, quantitative hepatitis B surface antigen; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate; ULN, upper limits of normal; US, ultrasonography.