Gastroenterology

Biography

Biography: Na Li

Abstract

Hepatitis B virus (HBV) infection is a global epidemic with estimated mortality 0.5-1.2 million deaths a year. Long-term goal of treatment on patients with chronic hepatitis B infection (CHB) is to reduce cirrhosis, hepatocellular carcinoma, and ultimately improve survival. The decision on initiating viral therapy can be complex because not all the patients with CHB derive significant clinical benefits from current medical therapies. Elevated HBV DNA level is a strong independent risk predictor of liver-related disease outcomes. Up to date, many studies have demonstrated improved clinical outcomes with successful viral suppression in CHB patients. Hepatic disease activity, assessed by histology and less accurately by alanine aminotransferase (ALT), is another major decision-making factor on initiating anti-viral therapy in patients with CHB. As in immune tolerance phase of CHB, characterized by high HBV DNA level, normal ALT, and no/minimal hepatic inflammation, disease progression is negligible. Treatment on these patients is therefore unlikely to alter long-term clinical outcomes. However, close monitoring of ALT level is highly recommended during immune tolerant phase as transition to immune clearance phase may occur. Anti-viral therapy is often required during immune clearance phase due to rapid disease progression. In patients with low HBV DNA and normal ALT, as seen in inactive carrier, medical therapy is typically not beneficial in long-term outcomes due to minimal risk of developing hepatic complications.