National Institute for Health and Clinical Excellence (NICE)
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Offer range of effective treatments for people with hep B

More people with hepatitis B should be assessed, referred and offered the range of clinical and cost effective treatments available for the disease, according to NICE.

Hepatitis B is a bloodborne infection, which can lead to chronic liver disease. It is most commonly transmitted by contact with infected blood, and through pregnant women passing the disease to their unborn child or when breastfeeding.

In the first few years after infection, there are often few or no symptoms meaning it can be difficult to know how many people have the disease. It is thought that around 180,000 people currently have hepatitis B, though the figure could be closer to 325,000 when the estimated 6500 people with chronic hepatitis B who migrate to the UK each year are taken into account.

While there has been progress in the treatment of hepatitis B over recent years, the condition is still under-recognised and misconceptions over its causes and the treatments available continue to exist.

A recent audit in London showed that a third of people with chronic hepatitis B infection diagnosed in primary care were not referred for further specialist services for assessment. Furthermore, anecdotal evidence suggests that there is wide variation in the choice of agents used for treatment.

NICE has published its first clinical guideline on the diagnosis and management of hepatitis B to raise awareness of the condition and help reduce this current variation in treatment.

The guideline covers the full pathway of care from diagnosis and assessment, to monitoring and the assessment of subsequent liver disease.

NICE recommends that GPs and other primary care professionals should offer a range of tests for people who are positive for hepatitis B surface antigen (HSsAg) - a viral protein detectable in the blood in acute and chronic hepatitis B infection.

Healthcare professionals should offer a particular sequence of treatment for adults with hepatitis B e antigen (HBeAg), which is an indication of viral replication, and compensated liver disease.

This sequence should start by offering a 48-week course of peginterferon alfa-2a as a first-line treatment, followed by tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion or who relapse after the first line treatment.

Further key recommendations cover women who are pregnant or breastfeeding, and preventative treatment for people who are receiving immunosuppressive therapy for other conditions, such as chemotherapy, bone marrow or solid organ transplantation.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said "Chronic hepatitis B can have a significant impact on a person's quality of life, particularly if it progresses to the fibrosis and cirrhosis stage."

"A great deal of progress has been made in treating hepatitis B but there is evidence that not everyone with the disease is being given the drugs they need to treat it, and not everyone who needs further assessment is referred to a specialist.

He added: "This guideline will reduce variation in practice and improve the care of people with chronic hepatitis B."

Emily Lam, patient/carer representative on the guideline development group, said: “The new guideline embraces the many effective treatments and proactive monitoring and surveillance measures now available.

"It is hoped that, by implementing this guideline, we will positively transform the outlook for patients with chronic hepatitis B, and greatly reduce the incidence of liver complications and liver cancer."

Dr Alan Mitchell, Clinical Director, Renfrewshire Community Health Partnership and East Renfrewshire CHCP and member of the guideline development group, said: "Chronic hepatitis B is a disease that for too long has been under-treated. GPs have a key role to play in the initial assessment of patients and their onward referral to specialist services and subsequent care.

He added: "I am confident that this guideline will prove very useful for GPs in their everyday practice in the assessment and management of patients with this very treatable infectious disease."

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