2018 CASL/AMMI management of HBV guidelines—‘a rose by any other name’?

To the Editor:

We appreciate the comments and constructive feedback by Burak et al (1) regarding the recently published Canadian Association for the Study of the Liver (CASL)/Association of Medical Microbiologists and Infectious Disease Canada (AMMI) management of hepatitis B guidelines. Although the 2018 guidelines strongly highlight the importance of fibrosis assessment, alanine aminotransferase cut-offs, and hepatitis B virus DNA viral load in treatment decisions, we welcome our colleagues’ suggestions for improving knowledge translation of the guidelines.

Knowledge translation is an iterative and dynamic process that involves optimizing information presentation on the basis of the target audience. The CASL/AMMI document presented consensus recommendations based on best practice, targeting a diverse group of knowledge users (i.e., health care providers and readership of the 2018 guidelines). The CASL/AMMI writing panel members invite the dissemination of these recommendations through print and through presentation, discussion, and comment on the content. The guideline algorithms were created to capture key written recommendations in a visual style, appropriate for a broad audience including primary care and specialist providers. We recognize that there is diversity in educational approaches to knowledge translation, and we welcome alternate strategies and further refinements such as those presented by Burak et al (1). However, rather than representing a missed opportunity to highlight aspects of hepatitis B management, we view the current guidelines as a reference document that forms the basis for development of further educational content, tailored to a specific target audience, which may vary in level of detail and points of emphasis.

The ‘Management of Hepatitis B Virus Infection: 2018 Guidelines’ are a product of a consensus process that included broad circulation to the CASL and AMMI membership. The writing panel incorporated all feedback received during this extensive consultation process and review before publication. The result is an inclusive document, endorsed by both society memberships that will, we hope, continue to stimulate conversation and knowledge exchange and improve management of hepatitis B in Canada. We believe that broad dissemination of these guidelines and others will help to achieve the goal of viral hepatitis elimination in Canada.

Funding:

No funding was received for this article

Disclosures:

Dr Coffin reports investigator- initiated research grant and research materials from GSK, Gilead Sciences, and Arbutus Biopharma; educational grants from Merck, Gilead Sciences, and Janssen Inc.; advisory board roles with Gilead Sciences, Springbank Pharmaceuticals, and GSK; Clinical Trial Guidance and Publication Committee role with Springbank Pharmaceuticals; and local-site principal investigator participation in clinical trials with Gilead Sciences, Springbank Pharmaceuticals, Janssen Inc., and Transgene. Dr Fung reports speaking and teaching fees from Gilead, Merck, and Abbvie and advisory board and consulting roles with Gilead, Merck, Abbvie, and Lupin. Dr Tam reports clinical investigator role with AbbVie, Allergan, BMS, Boehringer Ingelheim, Genfit, Gilead, Intercept, Janssen, Merck, Novartis, Roche, and Shire; advisory board role with AbbVie, BMS, Boehringer Ingelheim, Gilead, Intercept, Janssen, Lupin, Merck, PendoPharm, and Roche; and speaker honoraria from AbbVie, BMS, Gilead, Intercept, Merck, PenoPharm, and Roche.