Chronic Hepatitis B: A Critical Appraisal of Current Approaches to Therapy

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• 作者：Robert P. Perrillo¹ ; ^?/sup> ; ^{rperrillo@ochsner.org} ; Robert G. Gish^&Dagger ; ; Marion Peters^&sect ; ; ³ ; Emmet B. Keeffe^?/sup> ; ⁵ ; Alfredo Alberti^¶ ; ; Maria Buti^# ; W. Graham E. Cooksley^?? ; ⁹ ; Michael W. Fried^&Dagger ; &Dagger ; ; ⁷ ; Stephanos J. Hadziyannis^&sect ; &sect ; ; ⁸ ; Yun– ; Fan Liaw^¡Î¡Î ; ⁴ ; Nikolai V. Naoumov^¶ ; ¶ ; ; Eugene R. Schiff^## ; ¹⁰ ; Chloe L. Thio^???/sup> ; Naoky Tsai^&Dagger ; &Dagger ; &Dagger ; ; ² ; Solko Schalm^&sect ; &sect ; &sect ; ; ⁶
• 关键词：AASLD ; American Association for the Study of Liver Diseases ; ADV ; adefovir ; ALT ; alanine transaminase ; anti-HBc ; antibody to hepatitis B core antigen ; cccDNA ; covalently closed circular DNA ; CHB ; chronic hepatitis B ; ETV ; entecavir ; HBeAg ; hepatitis B e a
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2006
• 出版时间：February 2006
• 年：2006
• 卷：4
• 期：2
• 页码：233-248
• 全文大小：193 K

文摘

Background & Aims: Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature. Methods: A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20 % in any of the 5 graded levels of response (accept or reject) between the 2 groups. Results: With the exception of 2 statements, the experts?responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas. Conclusions: Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.