Editor's Note:From July 25 to 28, 2024, the Combined GIHep & SHC 2024 was held in Singapore. Dr. Jidong Jia from Beijing Friendship Hospital, Capital Medical University, participated in the Chronic Hepatitis B symposium and delivered a remarkable presentation on the new Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Edition) (hereinafter referred to as the "New Guidelines"). Hepatology Digest conducted an exclusive interview with Professor Jia to discuss the highlights of his presentation.Hepatology Digest: In your presentation at this conference, you shared insights from the New Guidelines for chronic hepatitis B. Could you briefly introduce the most critical updates in these guidelines?
Dr. Jidong Jia: The New Guidelines are internationally advanced in several respects. The core updates include: (1) expanded screening criteria; (2) broader indications for treatment; and (3) more stringent criteria for treatment cessation.
Additionally, the New Guidelines emphasize proactive treatment for children under six years old with chronic hepatitis, which is a significant departure from previous guidelines. Compared to earlier versions that primarily referenced international guidelines, this edition integrates more of China’s own clinical practice, evidence, and unique characteristics, earning recognition from the international academic community.
Hepatology Digest: What changes or new recommendations does the New Guidelines bring to the treatment of chronic hepatitis B patients compared to previous guidelines?
Dr. Jidong Jia: The New Guidelines introduce several important updates, with the most critical being the expanded indications for antiviral therapy.
Earlier guidelines typically set treatment criteria for HBeAg-positive hepatitis B patients as HBV DNA >2×10^5 IU/mL, and for HBeAg-negative patients as HBV DNA >2×10^4 IU/mL, with alanine aminotransferase (ALT) levels needing to be more than twice the upper limit of normal before initiating treatment. The New Guidelines have updated these criteria: first, the definition of serum HBV DNA positivity now requires the use of highly sensitive detection assays (with a detection limit of 10 IU/mL or 20 IU/mL). Second, for serum HBV DNA-positive patients, antiviral treatment is recommended regardless of ALT levels if any of the following conditions are met: (1) a family history of hepatitis B cirrhosis or HCC; (2) age >30 years; (3) non-invasive indicators or liver histology suggesting significant liver inflammation (G≥2) or fibrosis (F≥2); (4) HBV-related extrahepatic manifestations (e.g., HBV-associated glomerulonephritis).
Overall, the New Guidelines significantly broaden the scope of treatment for chronic hepatitis B patients, allowing more individuals to receive timely therapy and thereby increasing the likelihood of preventing the progression to liver fibrosis, cirrhosis, and liver cancer.
Hepatology Digest: What is the significance of the development and release of the New Guidelines in terms of international collaboration and exchange? Do you believe it will help advance global standards for chronic hepatitis B treatment?
Dr. Jidong Jia: In earlier versions of the guidelines, we mainly relied on and referenced international research evidence and recommendations. However, with the New Guidelines, we have achieved two important shifts. First, we have incorporated more domestic research data. Second, our recommendations are more tailored to China’s unique circumstances, and in the area of expanding treatment indications, we have even taken a leading role.
The release of the New Guidelines has garnered significant attention and recognition internationally, receiving widespread acclaim. More importantly, the World Health Organization and other international associations have, to some extent, drawn on our expanded treatment indications when revising their guidelines. Therefore, we are pleased to see that the New Guidelines are likely to have a considerable impact on the revision of other international guidelines.
Of course, we will continue to conduct clinical research based in China to generate more clinical evidence. We aim to elevate clinical experience to evidence and incorporate this new evidence into the guidelines, thereby further guiding clinical practice.
