Treatment of chronic hepatitis B infection: An update of Swedish recommendations

• Published in: Scandinavian journal of infectious diseases Vol. 40; no. 6-7; pp. 436 - 450
• Main Authors: Lindh, Magnus, Uhnoo, Ingrid, Bläckberg, Joans, Duberg, Ann-Sofi, Friman, Stybjörn, Fischler, Björn, Karlström, Olof, Norkrans, Gunnar, Reichard, Olle, Sangfeldt, Per, Söderström, Ann, Sönnerborg, Anders, Weiland, Ola, Wejstål, Rune, Wiström, Johan
• Format: Journal Article
• Language: English
• Published: Basingstoke Informa UK Ltd 2008; Taylor & Francis
• Subjects: Adenine - analogs & derivatives; Adenine - therapeutic use; Adenine/analogs & derivatives/therapeutic use; Antiviral Agents - therapeutic use; Biological and medical sciences; Carcinoma, Hepatocellular - prevention & control; Clinical Medicine; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Deoxycytidine/analogs & derivatives/therapeutic use; Drug Therapy, Combination; Emtricitabine; Guanine - analogs & derivatives; Guanine - therapeutic use; Guanine/analogs & derivatives/therapeutic use; Hepatitis B virus; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; HIV Infections - complications; Human immunodeficiency virus; Human viral diseases; Humans; Immunocompromised Host; Infectious diseases; Infectious Medicine; Infektionsmedicin; Infektionssjukdomar; Interferon Alfa-2a/therapeutic use; Interferon-alpha - therapeutic use; Klinisk medicin; Lamivudine - therapeutic use; Liver Cirrhosis - prevention & control; Liver Transplantation; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Microbiology in the medical area; Microbiology, immunology, infectious diseases; Mikrobiologi inom det medicinska området; Mikrobiologi, immunologi, infektionssjukdomar; Organophosphonates - therapeutic use; Phosphonic Acids/therapeutic use; Polyethylene Glycols - therapeutic use; Recombinant Proteins; Sweden; Tenofovir; Viral diseases; Viral hepatitis; Sweden; Europe; Infection; Viral hepatitis B; Treatment; Microbiology; Viral disease; Digestive diseases; Hepatic disease; Recommendation; Carcinoma; Hepatocellular/prevention & control; Combination; Drug Therapy; Chronic/complications/drug therapy; Hepatitis B
• ISSN: 0036-5548; 1651-1980; 1651-1980
• DOI: 10.1080/00365540802154769

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.