Chronic Hepatitis B Clinical Features

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Questions and Answers

What has supplanted standard interferon α as a therapy for chronic hepatitis B?

Interferon β

Adefovir

PEG IFN (correct)

Tenofovir

What is the estimated frequency of HBeAg seroconversion in lamivudine-resistant patients at year 4?

43% (correct)

30%

40%

What does long-term monotherapy with lamivudine risk in patients with cirrhosis?

Posttreatment flares (correct)

Improvement in histology

Increased treatment efficacy

Metabolic syndrome

In terms of efficacy, how does standard interferon compare to PEG IFN?

Standard interferon has no advantages. Signup and view all the answers

What was a significant issue noted during the clinical trial for adefovir?

Misallocation of drug versus placebo Signup and view all the answers

What percentage of patients can achieve undetectable HBV DNA levels with lamivudine?

~40% Signup and view all the answers

Which of the following correctly describes the treatment duration in clinical trials compared to clinical practice?

Generally, clinical practice uses shorter durations. Signup and view all the answers

What is the designation category for lamivudine regarding pregnancy safety?

Category C Signup and view all the answers

What is the recommended action for older patients with advanced fibrosis regarding the HBV DNA threshold?

Lower the HBV DNA threshold to >2 × 10^3 IU/mL. Signup and view all the answers

What is the suggested duration of consolidation therapy after HBeAg seroconversion in noncirrhotic patients?

12 months Signup and view all the answers

Which group of patients is recommended for indefinite therapy with oral agents?

HBeAg-negative patients Signup and view all the answers

How is pegylated interferon administered compared to oral nucleoside analogues?

Once a week via injection Signup and view all the answers

What is a common symptom associated with chronic hepatitis B?

Fatigue Signup and view all the answers

What does the current AASLD recommendation suggest regarding stopping antiviral treatment?

Stop after HBeAg seroconversion in noncirrhotics. Signup and view all the answers

What is the maximum mean HBV DNA suppression for pegylated interferon?

4.5 log10 Signup and view all the answers

What treatment is recommended as a first-line agent for chronic hepatitis B?

Entecavir Signup and view all the answers

Which of the following is considered a complication of cirrhosis in chronic hepatitis B?

Gastroesophageal varices Signup and view all the answers

What monitoring frequency is recommended for detecting recurrent viremia after stopping antiviral therapy?

Monthly for 6 months, then every 3 months for the rest of the year Signup and view all the answers

What could be a consideration for stopping therapy in HBeAg-negative patients?

HBsAg loss Signup and view all the answers

What are the detection thresholds of HBV DNA in sensitive amplification assays?

101−103 viral copies/mL Signup and view all the answers

What common feature is associated with severe or advanced cases of hepatitis?

Intermittent deepening of jaundice Signup and view all the answers

What was the first approved therapy for chronic hepatitis B?

Interferon-α Signup and view all the answers

Which of the following is NOT a symptom associated with chronic hepatitis B?

High blood pressure Signup and view all the answers

What is the treatment recommendation for patients with compensated cirrhosis and HBV DNA levels greater than 2 × 10^3 copies/mL?

Treated with oral agents, excluding PEG IFN Signup and view all the answers

When is treatment necessary for chronic hepatitis B patients with HBV DNA levels between 1 to 2 × 10^3 copies/mL?

Only treated if they are older than 40 with certain conditions Signup and view all the answers

What is a sign of hepatic decompensation in chronic hepatitis B?

Ascites Signup and view all the answers

In patients with undetectable HBV DNA and decompensated cirrhosis, what is the recommended course of action?

Observe the condition and refer for liver transplantation Signup and view all the answers

What is indicated for an HBeAg-negative chronic hepatitis B patient with HBV DNA levels less than or equal to 2 × 10^3 copies/mL?

Monitor the patient; treatment not necessary Signup and view all the answers

What should be done for patients with decompensated cirrhosis and detectable HBV DNA levels?

Treated with oral agents, not PEG IFN, and referred for liver transplantation Signup and view all the answers

For a chronic hepatitis patient with evidence of moderate to severe inflammation or fibrosis, what is the recommended action?

Start antiviral treatment regardless of age Signup and view all the answers

What is the approach for patients who are inactive carriers of HBV with DNA levels less than or equal to the upper limit of normal (ULN)?

Treatment is not necessary; observe the patient Signup and view all the answers

In HBeAg-reactive chronic hepatitis B, which factors are critical for considering treatment?

Age and family history related to liver disease Signup and view all the answers

What was the virologic relapse rate after prolonged courses of entecavir or tenofovir in the DARING-B study?

72% Signup and view all the answers

What percentage of patients in the FINITE study experienced HBsAg loss?

19% Signup and view all the answers

During which time frame was the greatest percentage of patients likely to experience HBsAg loss in the provided studies?

During >1 year of therapy Signup and view all the answers

In the DARING-B study, what was the percentage of patients who met the criteria for resuming therapy?

26% Signup and view all the answers

What was the percentage of HBeAg-negative responses at 4 years, according to the provided data?

7% Signup and view all the answers

What was the observed antiviral resistance rate after 1 year of lamivudine treatment?

~30% Signup and view all the answers

What sustained treatment-free outcomes percentage was reported in patients with 8 years of TDF treatment prior to stopping?

35–60% Signup and view all the answers

What percentage of patients had sustained responses without resumption of therapy in a study among Asian patients?

30% Signup and view all the answers

Study Notes

Clinical Features of Hepatitis B

Detection thresholds for hepatitis B virus (HBV) range from 10^5−10^6 virions/mL, with sensitive assays (PCR) measuring lower thresholds (10^1−10^3 copies/mL).
Common symptoms include fatigue, persistent or intermittent jaundice, malaise, and anorexia, often resembling acute hepatitis during exacerbations.
Complications of cirrhosis include ascites, hepatic encephalopathy, coagulopathy, and may require liver transplantation.

Treatment Options

Eight treatments approved for chronic hepatitis B; first-line agents include PEG IFN, entecavir, and tenofovir (TDF and TAF).
PEG IFN is preferred over standard interferon α due to better efficacy and weekly dosing.
Long-term treatment with lamivudine shows effectiveness in HBV DNA suppression, but resistance can develop (M204V or M204I mutations).

Monitoring and Treatment Guidelines

Monitoring after discontinuation of treatment is crucial; cautions exist for patients with cirrhosis due to risks of decompensation.
Treatment is guided by ALT levels and HBeAg status; patients with undetectable HBV DNA may not require treatment.
Recommended approach varies based on cirrhosis status (compensated vs. decompensated) and HBeAg presence; surveillance for hepatocellular carcinoma is suggested for high-risk patients.

Treatment Duration and Efficacy

Antiviral therapy can cease after HBeAg seroconversion, with a consolidation period of 12 months suggested.
HBeAg-negative patients may require indefinite therapy, terminating only after HBsAg loss.
Studies indicate high virologic relapse rates post-therapy, stressing long-term monitoring even after prolonged antiviral treatment.

Comparative Efficacy of Treatments

PEG IFN provides finite therapy (48 weeks); oral analogues often require prolonged duration.
Mean HBV DNA suppression is higher in oral agents compared to PEG IFN, promoting better disease control.
HBsAg loss rates vary between treatments, with oral nucleoside analogues showing more substantial long-term outcomes compared to interferon therapies.

Resistance to Treatment

Antiviral resistance primarily noted with lamivudine; alternative drugs demonstrate lower resistance rates.
The risk of treatment failure may increase with years on antiviral therapy, necessitating regular monitoring for effective management strategies.

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Description

This quiz covers the clinical and laboratory features associated with the detection thresholds of hepatitis B virions. It delves into the progression from acute to chronic hepatitis B and discusses the significance of HBV DNA measurements in clinical trials. Participants will enhance their understanding of the symptoms and diagnostic criteria related to this viral infection.