1056. Chronic Hepatitis B Treatment- A Comparison of Guidelines
Session: Poster Abstract Session: Guidelines in Clinical Practice
Saturday, October 22, 2011
Room: Poster Hall B1

Background:

Chronic hepatitis B prevalence is increasing in Ireland. Patients should be individually assessed for treatment. We audited HBV management comparing 2 sets of treatment recommendations - American (AASLD) and European (EASL), focusing on need for liver biopsy to aid treatment decisions.

Methods:

We performed a cross sectional analysis of 87 HBV monoinfected patients using both guidelines to assess treatment eligibility (parameters: HBeAg status, hepatitis B viral load, peak ALT and liver biopsy if performed). We then compared each guideline's impact on number of biopsies required to determine need for treatment.

Results:

87 HBV monoinfected patients were reviewed. 10 (11.36%) were treated for HBV; 8 (9.09%) ongoing and 2 (2.27%) treated during pregnancy. AASLD divides patients into 3 groups.

Group A (eAg+/-, HBV DNA> 20,000 IU/ml and ALT> 2x ULN (upper limit of normal), and should be treated; eAg+ patients need biopsy): 10 (11.36 %) patients: 6 eAg+, 4 eAg-. All eAg+ and 2 eAg- (biopsy showed inflammation) were treated. 2 other eAg- patients await biopsy. Of 77 untreated, 4 (5.19%) await biopsy (Group B: eAg-, HBV DNA >2000, ALT > 2x ULN; need biopsy prior to treatment decision), and the remaining 73 (94.80%) met Group C criteria for observation. With AASLD, 6 (7.79%) need biopsy for treatment decision.

EASL recommends liver biopsy if HBV DNA > 2000 IU/Ml and/or ALT > ULN, regardless of eAg; treatment indicated if liver biopsy shows fibrosis. Of 77 untreated patients, 21 (27.27%) had HBV DNA > 2000 IU/ml, 19 (24.67%) had ALT > ULN, 6 (7.79%) fulfill both criteria. From these 46, 3 had biopsies, 4 await biopsy, 2 failed follow-up. Liver biopsy is indicated in the remaining 37 (48.05%).

Conclusion:

This audit highlights discrepancies between treatment guidelines. AASLD is more specific for eAg, emphasizing biopsy if changing parameters suggest disease progression. From this, 6/77 (7.79%) await biopsy. EASL promotes biopsy; of 77 untreated patients, 37 (48.05%) require biopsy to determine treatment eligibility. Our institution has limited liver biopsy access and frequent cancellations due to bed availability. Implementing EASL guidelines would further stretch resources. Given the disparity, National Hepatitis B Treatment guidelines would be welcome.


Subject Category: J. Clinical practice issues

Katie McFaul, MRCPI, Department of Infectious Diseases, University Hospital Galway, Galway, Ireland and Catherine A Fleming, FRCPI, Department of Infectious Diseases, University College Hospital Galway, Galway, Ireland

Disclosures:

K. McFaul, None

C. A. Fleming, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.