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.
Lindh
Magnus
M
Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden. magnus.lindh@microbio.gu.se
Uhnoo
Ingrid
I
Bläckberg
Joans
J
Duberg
Ann-Sofi
AS
Friman
Stybjörn
S
Fischler
Björn
B
Karlström
Olof
O
Norkrans
Gunnar
G
Reichard
Olle
O
Sangfeldt
Per
P
Söderström
Ann
A
Sönnerborg
Anders
A
Weiland
Ola
O
Wejstål
Rune
R
Wiström
Johan
J
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
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