Chronic Hepatitis B: Update 2009
This guideline has been approved by the American Association for the Study of Liver Diseases and represents the position of the Association. It has been endorsed by the Infectious Diseases Society of America.
Anna S. F. Lok and Brian J. McMahon
Introduction
An estimated 350 million persons worldwide are chronically infected with HBV (8). In the United States, there are an estimated 1.25 million hepatitis B carriers, defined as persons positive for hepatitis B surface antigen (HBsAg) for more than 6 months.9-11Carriers of HBV are at increased risk of developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC) (12). Although most carriers will not develop hepatic complications from chronic hepatitis B, 15% to 40% will develop serious sequelae during their lifetime (13). The following guidelines are an update to previous AASLD guidelines and reflect new knowledge and the licensure of new antiviral agents against HBV. Recommendations in these guidelines pertain to the (1) evaluation of patients with chronic HBV infection, (2) prevention of HBV infection, (3) management of chronically infected persons, and (4) treatment of chronic hepatitis B. Management of hepatitis B in patients waiting for liver transplantation and prevention of recurrent hepatitis B post-liver transplant have been covered in a recent review article and will not be discussed in these guidelines (14).