Halting the natural history of hepatitis B viral infection: a paradigm shift.
The 2007 American Association for the Study of Liver Diseases (AASLD) practice guidelines for managing chronic hepatitis B virus (HBV) infection recommend pharmacologic therapy for patients with alanine aminotransferase (ALT) activity higher than 2 times the upper limit of normal and serum HBV DNA concentration higher than 20,000 IU/mL. Findings reported over the past several years, however, indicate that HBV infection associated with ALT activity and serum HBV DNA concentrations below these treatment thresholds can progress to serious liver disease, such as cirrhosis or hepatocellular carcinoma. These findings suggest that these treatment thresholds may be too conservative. Moreover, emerging data suggest that, in some patient populations, the appropriate goal of therapy may be sustained suppression of HBV DNA with maintenance antiviral therapy. A satellite symposium conducted during the 57th Annual Meeting of the AASLD in Boston, Massachusetts, presented new findings relative to the course of HBV infection.
Perrillo
Robert P
RP
Hepatology Division, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
Jacobson
Ira M
IM
D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control / Q000821:virology; D008113:Liver Neoplasms / Q000517:prevention & control / Q000821:virology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic
D000998:Antiviral Agents; D004279:DNA, Viral; D000410:Alanine Transaminase