[Therapy of hepatitis B virus infection].
In the last years there was a continuous improvement in the therapy of hepatitis B virus infection. Meanwhile different therapeutic options are available. Therefore the indication for the different treatment options can be chosen dependent on clinical, biochemical, virological and histological parameters. Therapy with interferon alpha or PEG-interferon alpha should be started if positive prognostic parameters and lack of contraindications are present in a patient. Especially therapy with PEG-interferon alpha in recent studies showed good response rates. As an alternative nucleosides/nucleotides like lamivudine, adefovir or entecavir are available. During lamivudine therapy there is an increased risk for the selection of resistant strains, while the selection of resistant strains is less frequent during the medication of adefovir or entecavir. However at present the end of treatment for all nucleosides/nucleotides--especially in HBeAg negative patients--is not clearly defined. In patients with liver cirrhosis (Child B and C) only nucleos(t)ides should be used. In the future combination therapy for the treatment of chronic HBV infection seems very attractive. However at present combination therapy is not approved yet and therefore these options should only be used in clinical studies. Especially, as it seems possible that synergistic, but also antagonistic effects may exist between different drugs.
Trautwein
C
C
Medizinische Klinik III, Universitätsklinikum der RWTH Aachen. ctrautwein@ukaachen.de
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004336:Drug Antagonism; D024882:Drug Resistance, Viral; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005544:Forecasting; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D011994:Recombinant Proteins; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D007166:Immunosuppressive Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D011092:Polyethylene Glycols; C413685:entecavir; D006147:Guanine; C053001:adefovir; C417083:peginterferon alfa-2b; D000225:Adenine; C100416:peginterferon alfa-2a