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Australian consensus recommendations for the management of hepatitis B

John S Lubel, Simone I Strasser, Alexander J Thompson, Benjamin C Cowie, Jennifer MacLachlan, Nicole L Allard, Jacinta Holmes, William W Kemp, Avik Majumdar, David Iser, Jess Howell and Gail V Matthews
Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51430
Published online: 7 March 2022

Abstract

Introduction: The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC).

Main recommendations: This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis.

Change in management as a result of this guideline: These recommendations aim to raise awareness of the current management of hepatitis B in Australia. Critically, the timely identification of individuals living with hepatitis B, and where appropriate, commencement of antiviral therapy, can prevent the development of cirrhosis, HCC and mother‐to‐child transmission as well as hepatitis B reactivation in immunocompromised individuals. Recognising patient and viral factors that predispose to the development of cirrhosis and HCC will enable clinicians to risk‐stratify and appropriately implement surveillance strategies to prevent these complications of hepatitis B.

  • John S Lubel1,2
  • Simone I Strasser3,4
  • Alexander J Thompson5,6
  • Benjamin C Cowie7,8
  • Jennifer MacLachlan7
  • Nicole L Allard6,7
  • Jacinta Holmes5,6
  • William W Kemp1
  • Avik Majumdar3
  • David Iser5
  • Jess Howell2,6,9
  • Gail V Matthews10,11

  • 1 Alfred Health, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC
  • 3 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
  • 4 University of Sydney, Sydney, NSW
  • 5 St Vincent’s Hospital Melbourne, Melbourne, VIC
  • 6 University of Melbourne, Melbourne, VIC
  • 7 WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
  • 8 Royal Melbourne Hospital, Melbourne, VIC
  • 9 Burnet Institute, Melbourne, VIC
  • 10 Kirby Institute, University of New South Wales, Sydney, NSW
  • 11 St Vincent’s Hospital Sydney, Sydney, NSW


Correspondence: J.Lubel@alfred.org.au

Acknowledgements: 

Unrestricted grant funding was provided to the Gastroenterological Society of Australia (GESA) for completion of this consensus statement. Details of GESA’s funding sources are available on the website (www.gesa.org.au). Funding was received from unrestricted grants provided by GESA and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), with editorial independence maintained throughout the manuscript development. These organisations provided logistical support only and they had no editorial involvement.

The following collaborators contributed to the design, participation in the mDELPHI process and in the reviewing of this manuscript as well as the online manuscript: Leon Adams, Golo Ahlenstiel, Tanya Applegate, Jennifer Audsley, David Baker, Robert Batey, Sally Bell, Scott Bowden, Wendy Cheng, Paul Clark, Jane Davies, Joshua Davis, Anouk Dev, John Didlick, Gregory Dore, Mark Douglas, Joe Doyle, Samuel Elliott, Jacob George, Michelle Giles, Behzad Hajarizadeh, Margaret Hellard, Thai Hong, Kelly Hosking, Sushena Krishnaswamy, Alice Lee, Christopher Leung, Miriam Levy, Ken Liu, Michaela Lucas, Mei Mak, Marianne Martinello, Geoffrey McCaughan, James O’Beirne, Christopher Pearce, Matthew Penn, Stephen Pianko, Dilip Ratnam, Peter Revill, Jacqui Richmond, Stuart Roberts, Joe Sasadeusz, Nick Shackel, William Sievert, Monica Slavin, Briohny Smith, Sally Spruce, Michael Stormon, Caroline Tallis, Edmund Tse, Thomas Tu, Kumar Visvanathan, Michael Wallace, James Ward, Amany Zekry.

We thank Joanne Mitchell (Project Officer) for her role in coordinating the members of the various working groups as well as providing logistical support for the mDELPHI meetings. [Corrections added on 10 Mar 2022 after first online publication: changes have been made to the Acknowledgements section to thank Joanne Mitchell.]

Competing interests:

John Lubel has no competing interests. Simone Strasser has received honoraria for advisory board or speaker fees from Bayer, Eisai, AbbVie, Gilead, BMS, MSD, Norgine, Astellas, Novartis, WL Gore, Ipsen, Pfizer, Astra Zeneca, Roche, Chiesi, Dr Falk, Guerbet Australia. Alexander Thompson has received funding from the National Health and Medical Research Council of Australia (MRFF Practitioner Fellowship 1142976), is an advisory board member for Abbvie, Gilead Sciences, Roche Diagnostics, BMS, Merck, Immunocore, Janssen, Assembly Biosciences, Arbutus, Vir Biotechnology, Eisai, Ipsen, Bayer; has received speaker fees from Abbvie, Gilead Sciences, Roche, BMS; and received research and grant support from Gilead Sciences, Merck, BMS, Abbvie, Roche Diagnostics. Jacinta Holmes is in the CSL advisory board and has received speaker fees from Gilead and AbbVie. William Kemp is in the advisory board of Gilead, Bayer and MSD, and has received speaker fees from AbbVie and Bayer. Avik Majumdar is in the advisory board of Gilead and Novartis, has received speaker fees from Gilead and Eisai, and is the recipient of a Gilead Fellowship research grant. David Iser has received speaker fees from AbbVie, Gilead and MSD, and is in the ASHM board of directors. Jessica Howells is the recipient of a Gilead Fellowship research grant. Gail Matthews has received research grants from Gilead and AbbVie

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