Diagnostic and therapeutic standards in chronic hepatitis type B Marta Wawrzynowicz-Syczewska Medical Science Review - Hepatologia 2009; 9 5-11 aaICID: 902235
Article type: Review article
IC™ Value: 3.04
Abstract provided by Publisher
The treatment of chronic B hepatitis is a real challenge for the clinician, who should be familiar with the natural course of the disease and the cross-resistance of the available antiviral drugs and should have access to a good diagnostic laboratory. Measurement of viremia by the very sensitive real-time PCR method is currently a diagnostic standard. Results should be given in international units per ml. Indications for treatment are the same for HBeAg positive and -negative chronic B hepatitis and are based on a serum HBV-DNA level >2000 IU/ml and/or elevated liver enzymes and histological activity. Six drugs are registered for treatment: interferons (recombinant and pegylated alpha-2a) and the nucleot(s)ide analogues (NUCs): lamivudine, adefovir dipivoxil, entecavir, and telbivudine. First-line treatment should be either interferon, because of the finite duration of treatment and better sustained response off-treatment compared with NUCs, or entecavir, because of its highest potency and high genetic barrier to resistance. A rational choice is sometimes difficult and depends on the clinical situation. Careful monitoring every 12 or 24 weeks is required. In case of primary non-response, partial response, or virological breakthrough, a change of drug or an appropriate modification of treatment is necessary.