Management of Chronic Hepatitis B: An Overview of Practice Guidelines for Primary Care Providers

Despite the introduction of hepatitis B virus (HBV) vaccination programs, chronic hepatitis B (CHB) remains an important disease burden worldwide and in the United States. A number of clinical practice guidelines are available to assist in the clinical management of CHB by providing recommendations regarding screening and diagnosis, treatment indications, and the choice, duration, and monitoring of treatment. Adherence to these guidelines has proven beneficial in terms of better treatment compliance, improved clinical outcomes, and lower likelihoods of emergency admission. This review summarizes current recommendations from the major clinical CHB practice guidelines and presents a simple algorithm for the treatment of patients with CHB to help primary care providers make informed choices in clinical practice. In general, antiviral treatment should be initiated in patients with CHB who have a high risk of liver-related morbidity and who are likely to respond to treatment, that is, patients with persistently elevated serum HBV DNA and either increased serum alanine aminotransferase concentrations or advanced liver disease. In patients who are eligible for antiviral therapy, treatment should be initiated with one of the recommended first-line therapies (pegylated interferon-alpha, entecavir, or tenofovir), and treatment efficacy should be monitored regularly for serum HBV DNA, alanine aminotransferase, and serologic responses. Patients who are not immediately considered for treatment should be monitored and started on antiviral therapy in case of disease progression. A number of issues in CHB management remain controversial or unresolved, such as identifying treatment candidates, managing partial or nonresponders, and predicting treatment response; we discuss some of the latest evidence around these topics.