Treatment of chronic hepatitis B infection : an update of Swedish recommendations

• The main goal for treatment of chronic hepatitis B is to prevent complications such as liver cirrhosis or hepatocellular carcinoma. Knowledge from population studies of the long-term risk of chronic HBV infection, as well as the recent introduction of pegylated interferon and additional nucleoside analogues has changed the therapeutic situation. Recently, a Swedish expert panel convened to update the national recommendations for treatment. The panel recommends treatment for patients with active HBV infection causing protracted liver inflammation or significant liver fibrosis, verified by liver histology. In general, pegylated interferon alpha-2a is recommended as first-line treatment, in particular for HBeAg-positive patients with HBV genotypes A or B. Among nucleoside analogues, entecavir is the first choice and adefovir or tenofovir can be used as alternatives. Lamivudine monotherapy is not recommended due to the high risk of resistance development. Combinations of nucleoside analogues such as tenofovir and lamivudine or emtricitabine are alternatives for patients with non-response or infection with resistant variants, or as first choice for patients with advanced liver disease. Nucleoside analogue treatment should be monitored to detect primary non-response and virological breakthrough. Special recommendations are given for HBV/HIV coinfected patients, immunosuppressed patients, children, and for treatment before and after liver transplantation. The present guideline is translated from Swedish, where it is published on the MPA and RAV websites (www.mpa.se and www.rav.nu.se) including 7 separate papers based on thorough literature search. The complete reference list can be received from the Medical Products Agency upon request.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Infektionsmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Infectious Medicine (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Mikrobiologi inom det medicinska området (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Microbiology in the medical area (hsv//eng)

Keyword

Adenine/analogs & derivatives/therapeutic use

Antiviral Agents/*therapeutic use

Carcinoma; Hepatocellular/prevention & control

Deoxycytidine/analogs & derivatives/therapeutic use

Drug Therapy; Combination

Guanine/analogs & derivatives/therapeutic use

HIV Infections/complications

Hepatitis B; Chronic/complications/*drug therapy

Humans

Immunocompromised Host

Interferon Alfa-2a/therapeutic use

Lamivudine/therapeutic use

Liver Cirrhosis/prevention & control

Liver Transplantation

Phosphonic Acids/therapeutic use

Polyethylene Glycols/therapeutic use

Sweden

MEDICINE

MEDICIN

Infectious diseases

Infektionssjukdomar

Infektionssjukdomar

Infectious Diseases

Publication and Content Type

ref (subject category)

for (subject category)