Guidelines

South African guideline for the management of chronic hepatitis B: 2013

C W N Spearman, Mark W Sonderup, J F Botha, S W van der Merwe, E Song, C Kassianides, K A Newton, H N Hairwadzi

Abstract


Hepatitis B remains a significant yet preventable health issue in South Africa. The introduction of the hepatitis B vaccine into the country some 18 years ago has demonstrated benefit, but the exposure to, and prevalence of chronic HBsAg positivity remain unacceptably high. Those with chronic hepatitis B virus infection have an elevated risk of developing cirrhosis with end-stage liver disease and a markedly elevated risk of hepatocellular carcinoma, independent of the presence of cirrhosis.
The challenge in South Africa remains prevention through the universal vaccination coverage of all children and the identification of those with chronic hepatitis B virus infection. Over the last decade our understanding of hepatitis B and its behaviour and natural history in those with chronic infection has significantly improved. This understanding is key to identifying those who warrant further evaluation and therapy. A number of global societies have updated their guidelines in recent years. This document draws on these guidelines and serves to contextualise, for South Africa, practice guidelines for the management of chronic hepatitis B.

Authors' affiliations

C W N Spearman, Division of Hepatology, Department of Medicine, University of Cape Town

Mark W Sonderup, Division of Hepatology, Department of Medicine, University of Cape Town; South African Gastroenterology Society, Mowbray, Cape Town

J F Botha, South African Gastroenterology Society, Mowbray, Cape Town; Sandton Clinic, Bryanston, Johannesburg

S W van der Merwe, Department of Immunology, University of Pretoria; Department of Clinical and Experimental Medicine, University of Leuven, Flanders

E Song, Department of Medicine, University of the Witwatersrand, Johannesburg; Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg

C Kassianides, Morningside Clinic, Sandton, Johannesburg; Gastroenterology Foundation in South Africa, Mowbray, Cape Town

K A Newton, South African Gastroenterology Society, Mowbray, Cape Town; Department of Gastroenterology, Division of Clinical Medicine, University of KwaZulu-Natal, Durban

H N Hairwadzi, Division of Hepatology, Department of Medicine, University of Cape Town

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Keywords

Hepatitis B

Cite this article

South African Medical Journal 2013;103(5):335-349. DOI:10.7196/SAMJ.6452

Article History

Date submitted: 2012-10-30
Date published: 2013-03-20

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