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      Guidelines for the Prevention and Treatment of Chronic Hepatitis B (version 2022)

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          Abstract

          To facilitate the achieving of the goal of “eliminating viral hepatitis as a major public health threat by 2030” set by the World Health Organization, the Chinese Society of Hepatology together with the Chinese Society of Infectious Diseases (both are branches of the Chinese Medical Association) organized a panel of experts and updated the guidelines for prevention and treatment of chronic hepatitis B in China (version 2022). With the support of available evidence, this revision of the guidelines focuses on active prevention, large scale testing, and expansion of therapeutic indication of chronic hepatitis B with the aim of reducing the hepatitis B related disease burden.

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          EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.

          Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase. All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors. The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint. The typical indication for treatment requires HBV DNA >2,000IU/ml, elevated ALT and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide, represents the treatment of choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All treated and untreated patients should be monitored for treatment response and adherence, and the risk of progression and development of complications. HCC remains the major concern for treated chronic hepatitis B patients. Several subgroups of patients with HBV infection require specific focus. Future treatment strategies to achieve 'cure' of disease and new biomarkers are discussed.
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            Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.

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              Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus

              Human hepatitis B virus (HBV) infection and HBV-related diseases remain a major public health problem. Individuals coinfected with its satellite hepatitis D virus (HDV) have more severe disease. Cellular entry of both viruses is mediated by HBV envelope proteins. The pre-S1 domain of the large envelope protein is a key determinant for receptor(s) binding. However, the identity of the receptor(s) is unknown. Here, by using near zero distance photo-cross-linking and tandem affinity purification, we revealed that the receptor-binding region of pre-S1 specifically interacts with sodium taurocholate cotransporting polypeptide (NTCP), a multiple transmembrane transporter predominantly expressed in the liver. Silencing NTCP inhibited HBV and HDV infection, while exogenous NTCP expression rendered nonsusceptible hepatocarcinoma cells susceptible to these viral infections. Moreover, replacing amino acids 157–165 of nonfunctional monkey NTCP with the human counterpart conferred its ability in supporting both viral infections. Our results demonstrate that NTCP is a functional receptor for HBV and HDV. DOI: http://dx.doi.org/10.7554/eLife.00049.001
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                Author and article information

                Journal
                J Clin Transl Hepatol
                J Clin Transl Hepatol
                JCTH
                Journal of Clinical and Translational Hepatology
                XIA & HE Publishing Inc.
                2225-0719
                2310-8819
                28 November 2023
                15 August 2023
                : 11
                : 6
                : 1425-1442
                Affiliations
                [1 ]Beijing Friendship Hospital, Capital Medical University, Beijing, China
                [2 ]The Fifth Medical Center of PLA General Hospital, Beijing, China
                [3 ]Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
                [4 ]Peking University First Hospital, Beijing, China
                [5 ]Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
                [6 ]Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
                [7 ]Beijing You-An Hospital, Capital Medical University, Beijing, China
                [8 ]Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
                [9 ]Peking University Health Science Center, Beijing, China
                Author notes
                [* ] Correspondence to: Hong You, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. ORCID: https://orcid.org/0000-0001-9409-1158. Email: youhongliver@ 123456ccmu.edu.cn ; Fusheng Wang, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China. ORCID: https://orcid.org/0000-0002-8043-6685. Tel: +86-10-66933333, Fax: +86-10-66933332, Email: fswang302@ 123456163.com ; Taisheng Li, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. Email: litsh@ 123456263.net ; Xiaoyuan Xu, Peking University First Hospital, Beijing 100034, China. ORCID: https://orcid.org/0000-0002-1759-4330. Tel/Fax: +86-10-83575787, Email: xiaoyuanxu6@ 123456163.com .

                None to declare.

                HY and YN have been editorial board members of Journal of Clinical and Translational Hepatology, FW, JH, LW and JJ have been executive associate editors of Journal of Clinical and Translational Hepatology. The other authors have no conflict of interests related to this publication.

                Author information
                https://orcid.org/0000-0001-9409-1158
                https://orcid.org/0000-0002-8043-6685
                https://orcid.org/0000-0002-1759-4330
                Article
                JCTH.2023.00320
                10.14218/JCTH.2023.00320
                10500285
                37719965
                0b874c0d-853d-46a6-8e75-f64460ce28cc
                © 2023 Authors.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 July 2023
                : 2 August 2023
                : 3 August 2023
                Categories
                Guideline

                chronic hepatitis b,treatment,prevention,guideline
                chronic hepatitis b, treatment, prevention, guideline

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