[Therapy of problem cases in hepatitis B].

¹Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Medizinische Fakultät der Humboldt-Universität zu Berlin.

|July 14, 2000

Summary

New treatments for hepatitis B offer hope, with lamivudine (LAM) a key option for chronic cases and post-transplant management. Careful consideration of advanced cirrhosis and co-infections guides therapy choices.

Area of Science:

Hepatology
Virology
Pharmacology

Context:

Recent advancements in hepatitis B therapeutics.
Focus on managing chronic hepatitis B, including HBeAg-negative/anti-HBe-positive patients with HBV-mutant replication.
Special considerations for fulminant hepatitis B, liver transplantation, and extrahepatic manifestations.

Purpose:

To outline current therapeutic strategies for various hepatitis B virus (HBV) infection scenarios.
To guide treatment decisions based on disease stage, viral load, and patient status (e.g., post-transplantation).
To highlight the role of lamivudine (LAM) and interferon (IFN) in HBV management.

Summary:

Lamivudine (LAM) is a primary treatment for chronic hepatitis B (CHB) and HBV-cirrhosis (Child A), and for managing viremia before liver transplantation.
For progressed cirrhosis (Child B/C) without transplant options, nucleos(t)ide analogues are generally not indicated, and interferon is contraindicated.
Post-liver transplant, passive immunoprophylaxis with anti-HBs-hyperimmunoglobulin is crucial; LAM is used for reinfection, with interferon alpha as a LAM-resistance option. LAM is also recommended for HBV-infected renal transplant patients, avoiding IFN to prevent graft rejection.
Combined HBV infections (HDV, HCV, HIV) require individualized treatment plans.
Extrahepatic manifestations of HBV infection warrant antiviral treatment, potentially combined with glucocorticosteroids and LAM.

Impact:

Provides a framework for optimizing hepatitis B treatment strategies.
Emphasizes the importance of individualized care based on specific patient conditions and viral characteristics.
Informs clinical decision-making for healthcare professionals managing HBV patients.

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