New guidelines for the treatment of Chronic Hepatitis B in Kuwait

The guidelines will offer insights to treating physicians on the health implications of hepatitis B: for everything from liver disease assessment to individualized treatment approaches and monitoring patient response. They will also provide physicians with the framework for determining the most appropriate treatment options to ensure long-term efficacy and minimal resistance.

"Hepatitis B is a dangerous liver disease and is the primary cause for liver cancer. The Middle East is defined as a moderate-prevalence region where HBV infection rates range from two to eight percent. In Kuwait, HBV prevalence is around two to five percent,"

said Dr Al Ali.

"It is critical that we adopt the most efficient treatment options to avoid costly and often difficult to treat consequences. The goal of therapy for hepatitis B is to improve quality of life by preventing progression of the disease to cirrhosis, end-stage liver disease and liver cancer. This underlines the importance of screening and early detection."

A panel of Kuwaiti hepatologists are developing a comprehensive treatment algorithm for chronic hepatitis B, which supports the American Association for the Study of Liver Disease (AASLD) updated guidelines. The panel members are considering the following questions:
- How should liver disease be assessed before therapy?
- What are the goals and end-points of treatment?
- What are the definitions of response?
- What is the optimal approach to first-line treatment?
- What definitions of resistance should be applied and how should resistance be managed?
- How should treatment be monitored?
- When can treatment be stopped?
- How should special groups be treated?
- What are the current unresolved issues?

The guidelines will also provide recommendations on when to start treatment, which are based on the combination of three criteria: the amount of virus in the blood (viral load), serum alanine aminotransferase (ALT) levels, and liver inflammation/fibrosis stage (histology).

"Previously a limited number of antiviral treatment options were available, including lamivudine and adefovir. While these treatments may be efficacious, in many cases they can lead to resistance," said Dr Al Ali. "The guidelines will offer recommendations on selecting the best treatment strategy to maintain the viral load at undetectable levels, hence avoid progression of liver complications and long term resistance."