Miller School Liver Specialist Leads National Study Updating Chronic Hepatitis B Treatment

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A panel of North American hepatologists, including a liver specialist at the University of Miami Miller School of Medicine, has updated an algorithm to manage chronic hepatitis B (CHB) infection, a leading cause of liver cancer and cirrhosis around the world.

Paul Martin, M.D.

“Our goal was to offer a guide to clinicians in managing this complex disease in order to avoid irreversible scarring of the liver that can result in poor outcomes,” said Paul Martin, M.D., chief of the Division of Digestive Health and Liver Diseases, Mandel Chair in Gastroenterology, and professor of medicine at the Miller School.

Martin was the first author in collaboration with his colleagues of the paper, "Treatment Algorithm for Managing Chronic Hepatitis B Virus Infection in the United States: 2021 Update," published in the journal, Clinical Gastroenterology and Hepatology. The new study updates prior CHB algorithms published in 2004, 2006, 2008 and 2015.

"Several developments in the past six years have altered the management of CHB,” Martin said..

For example, he said tenofovir alafenamide has been introduced as an initial antiviral choice as well as an alternative for long-term therapy. Clinicians are also able to use a new antigen test to monitor response to treatment.

An Alternative Therapy

Martin added that recent evidence indicates that it may be helpful to begin preventive therapy even if the viral infection appears to be inactive.

"Chronic hepatitis B can be setting the stage for liver cancer, even if the disease is not progressing,” he said. "These studies point to the need for earlier interventions than recommended in the past.”

Antiviral therapy can also help prevent hepatitis B virus transmission from a pregnant mother to her baby and reduce the risk of reactivation in patients undergoing chemotherapy or immunotherapy, he added.

In the United States, an estimated 840,000 to 1.59 million individuals are chronically infected with hepatitis B virus, according to the report. Despite vaccinations given at birth, substantial numbers of adults have already been infected with hepatitis B virus and remain at risk of progressive liver disease.

Also, the average age of CHB patients in the U.S. has increased in the past six years, indicating that the use of biologics associated with aging will increasingly affect disease management.

“The study recommendations have been based on evidence from the scientific literature, when possible, as well as clinical experience and consensus expert opinion,” Martin said. “Since current therapies are suppressive rather than curative, more research is needed to find ways to eradicate this chronic viral infection.”

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