Author's Note: Significant advances in the diagnosis and management of patients with liver disease were presented at The Liver Meeting® 2014, the annual meeting of the American Association for the Study of Liver Diseases (AASLD). Investigators highlighted progress in the understanding of common issues, including the availability of novel diagnostic and therapeutic options, as well as valid screening methodology to ensure optimal outcomes for patients. It is an exciting time for hepatology; research presented promises to alter clinical practice in the near future. Some of the concepts that emerged in the diagnosis and treatment of hepatitis B are highlighted here.
Serologic Testing Rates Among US Veterans With HBV
Serper and colleagues queried the Veterans Administration Corporate Data Warehouse to identify adult patients with any positive hepatitis B surface antigen (HBsAg) result from 2002 to 2014. Chronic hepatitis B virus (HBV) infection was found to be approximately four times more common among veterans than in the general US population. Among HBsAg-positive veterans, rates of serologic testing as recommended by the AASLD for treatment stratification were suboptimal. Among those tested, adherence to treatment guidelines was also low, particularly for hepatitis B e antigen (HBeAg)-negative individuals. These data suggest that significant provider education and improvement in clinical processes are needed to improve provider adherence to testing and treatment guidelines for HBV.
Multiplex PCR Assay for Hepatitis A, B, C, D, and E
Nucleic acid testing (NAT) remains the gold standard for diagnosis of active and viremic stages of infection. NAT methodologies based on qualitative and quantitative polymerase chain reaction (PCR) have been developed for hepatitis A virus, HBV, hepatitis C virus, hepatitis delta virus, and hepatitis E virus. Kodani and colleagues designed standardized TaqMan® assays (Life Technologies, Carlsbad, California) for simultaneous detection of all five viruses, which were concordant with individual NATs for hepatitis A-E viral genomes, and can be used for simultaneous detection of these genomes in a multiplex format.The assay has the potential for use in hepatitis surveillance and for screening of clinical specimens in outbreak situations.
Mother-to-Infant HBV Transmission
Mother-to-child transmission of HBV is especially likely when the maternal viral load is high and HBeAg positivity is present. Antiviral therapy during pregnancy to reduce viral load remains a challenge because safety data are limited, but data on the safety and efficacy of several antivirals were presented at this year's meeting.
Tenofovir disoproxil. Huang and colleagues evaluated the safety and reliability of tenofovir, given during the entire pregnancy, in preventing mother-to-child transmission of HBV. The cord blood of all infants was negative for HBV DNA, and all babies were negative for HBsAg and HBV DNA at 20-48 weeks of age. The drug was well tolerated, and no congenital diseases were reported.
Yi and colleagues also evaluated the safety of tenofovir administered during the entire pregnancy in managing elevated alanine aminotransferase (ALT) levels. At 28 weeks of age, none of the infants in the tenofovir group were positive for HBsAg compared with 6.5% of untreated infants. Treatment throughout pregnancy was safe for both mothers and infants. Tenofovir therapy suppressed maternal viremia with normalization of ALT levels and may reduce immunoprophylaxis failure in infants.
Telbivudine. Sheng and colleagues evaluated the efficacy and safety of telbivudine for preventing mother-to-infant HBV transmission in more than 4500 chronically infected (immune-tolerant phase) pregnant women.The HBsAg carrier rate was 6%; 67% were positive for HBeAg, and 83% had detectable HBV DNA. Telbivudine treatment effectively and safely prevented mother-to-infant transmission of HBV from chronically infected mothers with a high degree of viremia late in pregnancy. When assessed at 7 months after birth, none of the infants had developed HBV infection.