Current opinion in infectious diseases · 2012
Diagnosis and personalized management of hepatitis B including significance of genotypes.
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Wong Vincent Wai-Sun, Sung Joseph Jao-Yiu
Аннотация
PURPOSE OF REVIEW: Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma globally. This article reviews recent therapeutic developments and highlights the significance of HBV genotypes.
RECENT FINDINGS: Seven drugs (two interferons and five oral antiviral drugs) are currently available for the treatment of chronic hepatitis B. Peginterferon has the advantage of finite treatment duration and higher off-treatment durability, but causes more side effects. On-treatment monitoring with hepatitis B surface antigen and HBV DNA levels can predict response and serve as a stopping rule. Oral antiviral therapy carries fewer side effects, but long-term treatment is often required. Regular HBV DNA monitoring is essential for detecting drug resistance and suboptimal responders. HBV is divided into eight genotypes based on a difference in genetic sequence of 8% or more. Genotype C is associated with prolonged immune clearance and a higher risk of progression to cirrhosis and hepatocellular carcinoma. Patients with genotype D HBV infection have low response rate of 7-25% to peginterferon.
SUMMARY: The availability of effective antiviral therapy and virological assays has transformed HBV treatment in the past two decades. The differences in response rate and side-effect profile call for individualized treatment selection.
RECENT FINDINGS: Seven drugs (two interferons and five oral antiviral drugs) are currently available for the treatment of chronic hepatitis B. Peginterferon has the advantage of finite treatment duration and higher off-treatment durability, but causes more side effects. On-treatment monitoring with hepatitis B surface antigen and HBV DNA levels can predict response and serve as a stopping rule. Oral antiviral therapy carries fewer side effects, but long-term treatment is often required. Regular HBV DNA monitoring is essential for detecting drug resistance and suboptimal responders. HBV is divided into eight genotypes based on a difference in genetic sequence of 8% or more. Genotype C is associated with prolonged immune clearance and a higher risk of progression to cirrhosis and hepatocellular carcinoma. Patients with genotype D HBV infection have low response rate of 7-25% to peginterferon.
SUMMARY: The availability of effective antiviral therapy and virological assays has transformed HBV treatment in the past two decades. The differences in response rate and side-effect profile call for individualized treatment selection.