Hepatitis B—More Treatments, More Testing, Not Enough Data

Excerpt

Chronic hepatitis B virus (HBV) infection has a much greater impact globally than in the US, yet even in the relatively low-prevalence US population, 1.25 million people are chronically infected, and an estimated 15–40% of those develop cirrhosis.1‐3 Chronic HBV is less prevalent in the US than hepatitis C virus (HCV) infection,4 but the likelihood that patients with HBV will die from liver-related disease is much higher than with HCV.3 Furthermore, HBV has four phases of infection and a more variable natural history, with nonlinear, alternating progression of disease stages,5 making long-term management more complex and labor intensive. The modern era of HBV management now includes the use of quantitative tests of HBV DNA in initial diagnostic and routine long-term management,6 and the potential use of any of seven currently available HBV treatments.5 Although screening for HBV and appropriate vaccination for HBV still need increased attention and implementation,7 patients with established chronic HBV need lifelong monitoring, and this will generally be done in the primary care setting. …