2018-AASLD慢乙肝指南更新.ppt

和2016版指南不同，2018版AASLD指南由专家组共识意见发展而来，并没有对文献进行正式的系统回顾，也没有组织多学科专家组使用GRADE系统来对证据质量和推荐力度进行评级，它主要基于：①相关话题已发表文献的正式综述和分析；②WHO慢性乙型肝炎患者的预防、关爱和治疗指南；③作者在急性乙肝和慢乙肝方面的经验。 1. Screening should be performed using both HBsAg and anti-HBs. 2. Screening is recommended in all persons born in countries with a HBsAg seroprevalence of ≥2%, US-born persons not vaccinated as infants whose parents were born in regions with high HBV endemicity (≥8%), pregnant women, persons needing immunosuppressive therapy, and the at-risk groups listed in Table 3. 3. Anti-HBs–negative screened persons should be vaccinated. 4. Screening for anti-HBc to determine prior exposure is not routinely recommended but is an important test in patients who have HIV infection, who are about to undergo HCV or anticancer and other immunosuppressive therapies or renal dialysis, and in donated blood (or, if feasible, organs) (see SCREENING, COUNSELING, AND PREVENTION OF HEPATITIS B, section 6D). 1A. The AASLD recommends antiviral therapy for adults with immuneactive CHB (HBeAg negative or HBeAg positive) to decrease the risk of liver-related complications 1B. The AASLD recommends peg-IFN, entecavir, or tenofovir (TDF) as preferred initial therapy for adults with immune-active CHB 2A. The AASLD recommends against antiviral therapy for adults with immune tolerant CHB 2B. The AASLD suggests that ALT levels be tested at least every 6 months for adults with immune tolerant CHB to monitor for potential transition to immuneactive or immune-inactive CHB 2C. The AASLD suggests antiviral therapy in the select group of adults 40 years of age with normal ALT and elevated HBV DNA (1,000,000 IU/mL) and liver biopsy specimen showing significant necroinflammation or fibrosis 3A. The AASLD suggests that HBeAg-positive adults without cirrhosis but with CHB who seroconvert to anti-HBe on therapy discontinue NAs after a period of treatment consolidation 3B. The AASLD suggests indefinite antiviral therapy for HBeAg-positive adults with cirrhos