Chronic hepatitis B: a critical appraisal of current approaches to therapy.
OBJECTIVE
Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature.


METHODS
A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups.


RESULTS
With the exception of 2 statements, the experts' responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas.


CONCLUSIONS
Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.
Perrillo
Robert P
RP
Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA. rperrillo@ochsner.org
Gish
Robert G
RG
Peters
Marion
M
Keeffe
Emmet B
EB
Alberti
Alfredo
A
Buti
Maria
M
Cooksley
W Graham E
WG
Fried
Michael W
MW
Hadziyannis
Stephanos J
SJ
Liaw
Yun-Fan
YF
Naoumov
Nikolai V
NV
Schiff
Eugene R
ER
Thio
Chloe L
CL
Tsai
Naoky
N
Schalm
Solko
S
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D002983:Clinical Competence; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage; D008099:Liver / Q000473:pathology; D063065:Organophosphonates / Q000008:administration & dosage; D018579:Patient Selection; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011994:Recombinant Proteins; D012955:Societies, Medical; D014779:Virus Replication
D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C053001:adefovir; D007372:Interferons; D000410:Alanine Transaminase; D000225:Adenine; C100416:peginterferon alfa-2a