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Lege Artis Medicinae

NOVEMBER 19, 2006



[Today, there are less patients with active chronic hepatitis B requiring treatment than patients with chronic hepatitis C. However, the course and outcome of chronic hepatitis B is usually more severe, therefore, the disease has not lost importance. The most dangerous risks are the development of liver cirrhosis and hepatocellular carcinoma. The disease may present in various forms. Symptom-free carriers only need follow-up and hepatologic care. In the active stages with elevated liver enzymes and high level of viral nucleic acid (either HBeAg negative or positive), however, antiviral treatment is strongly indicated. There are two main forms of treatment. Alfa-interferon-based therapy, which is applied for a defined period of time, has a direct antiviral and immunomodulatory effect, but has several adverse effects. Long-term nucleoside analogue treatment represent the other treatment modality. These drugs are administered orally, have minimal side effects, but after some time resistant mutants may develop. Traditional interferon has recently been replaced by pegylated interferon alfa-2a with much better pharmacokinetic properties. Lamivudine has been in use for the longest time of the nucleoside analogues. Its efficacy is high, but after 3 to 4 years of treatment, resistant mutants appear in about 70% of cases. Of the most recent compounds, adefovir dipivoxil has recently become available in Hungary; it is primarily recommended in cases with lamivudine resistant mutants. There are promising new drugs in the stages of clinical trial; of these, entecavir has already been approved in the United States.]

Lege Artis Medicinae

NOVEMBER 10, 2008



[Hepatitis B virus infection is a significant health problem worldwide, as well as in Hungary. The chronic infection is usually symptomless, its most dangerous risks are liver cirrhosis and hepatocellular carcinoma. The latter may occur without development of liver cirrhosis, so it means a potential complication for patients with inactive phase of infection, as well. Criteria of the indication of antiviral treatment have changed in the last years due to the flare of our knowledge about the natural history of the disease. In our days quantitative determination of hepatitis B viral nucleic acid titer is essential for diagnosis. Formerly, a HBsAg positive patient with normal liver enzymes had been regarded as inactive carrier, and antiviral treatment had not been advised. In our days, the phase of the infection and the necessity of the treatment can not be determined without measurement of nucleic acid titer. Liver biopsy and, if inflammation or fibrosis is present, antiviral treatment is indicated, if the nucleic acid titer is >20 000 IU/ml in HBeAg positive, and >2000 IU/ml in HBe negative cases, respectively. Interferon alpha is the gold standard of treatment for chronic B hepatitis. Pegylated interferon alpha-2a is used because of its better pharmacokinetic properties. Oral agents include nucleoside/ nucleotide analogues with rare and mild adverse effects, and they may be given to patients with decompensated liver disease. Their main disadvantages include the development of drug-resistance, and the very low ratio of HBsAg-anti-HBs seroconversion. Recent drugs like adefovir, entecavir and tenofovir have replaced lamivudin, which has been in use for the longest time, because they are more effective and resistance against them is less frequent.]