title: Treatment of chronic hepatitis B infection: an update of Swedish recommendations.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden. magnus.lindh@microbio.gu.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindh
authors.forename: Ingrid
authors.initials: I
authors.lastname: Uhnoo
authors.forename: Joans
authors.initials: J
authors.lastname: Bläckberg
authors.forename: Ann-Sofi
authors.initials: AS
authors.lastname: Duberg
authors.forename: Stybjörn
authors.initials: S
authors.lastname: Friman
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
authors.forename: Olof
authors.initials: O
authors.lastname: Karlström
authors.forename: Gunnar
authors.initials: G
authors.lastname: Norkrans
authors.forename: Olle
authors.initials: O
authors.lastname: Reichard
authors.forename: Per
authors.initials: P
authors.lastname: Sangfeldt
authors.forename: Ann
authors.initials: A
authors.lastname: Söderström
authors.forename: Anders
authors.initials: A
authors.lastname: Sönnerborg
authors.forename: Ola
authors.initials: O
authors.lastname: Weiland
authors.forename: Rune
authors.initials: R
authors.lastname: Wejstål
authors.forename: Johan
authors.initials: J
authors.lastname: Wiström
mesh_terms: D006801:Humans; D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications; D016867:Immunocompromised Host; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000517:prevention & control; D016031:Liver Transplantation; D063065:Organophosphonates / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D013548:Sweden; D000068698:Tenofovir
chemical_list: D000225:Adenine; D000998:Antiviral Agents; D003841:Deoxycytidine; D000068679:Emtricitabine; C413685:entecavir; D006147:Guanine; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D019259:Lamivudine; D063065:Organophosphonates; C100416:peginterferon alfa-2a; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D000068698:Tenofovir