REVIEW – October 2013

Recommendations for management of chronic hepatitis B

Authors: Riina Salupere, Matti Maimets, Benno Margus, Kristi Ott, Kai Zilmer

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The objective of the practice guideline is to update the natural history of hepatitis B virus infection and to give recommendations for optimal management of chronic hepatitis B.

The guideline is based on the best available evidence. The goal of treatment of chronic hepatitis B is to improve quality of life and survival by preventing progression of hepatitis to cirrhosis and hepatocellular carcinoma.

The progression of liver disease is associated with HBV DNA level in the blood. In HBeAgpositive and HBeAg-negative patients, the ideal end-point of treatment is sustained HBsAg loss. Maintained undetectable HBV DNA under long-term antiviral treatment in HBeAg-positive patients who do not achieve antiHBe seroconversion and in HBeAg-negative patients is the next most desirable end point.

Indication for treatment is identical for HBeAg-positive and HBeAg-negative patients and is based on a combination of serum HBV DNA level, ALAT elevation, and liver histology.

Treatment should be considered in patients with HBV DNA level above 2000 IU/ml, seerum ALAT level above the upper limit of normal, severity of liver disease, assessed by liver biopsy, showing moderate to severe active necroinfl ammation and/or at least moderaate fibrosis. All patients with B-cirrhosis and positiive HBV DNA should be treated, regardless of their HBV DNA and ALAT level.

Currently, there are two treatment strategies for both HBeAg-positive and HBeAgnegative chronic hepatitis B patients. Treatment can be of finite duration with pegylated interferon alfa2a or long-term continuous with entecavir or tenofovir disoproxil. Pegylated interferon alfa2a can be used for

HBeAg-positive and HBeAg-negative chronic hepatitis B patients. Long-term treatment with entecavir or tenofovir disoproxil is necessary for patients with B-cirrhosis, for patients who fail with pegylated interferoon alfa2a to achieve virological response and require extended treatment, as well as for patients who have contraindications to pegylated interferon alfa2a treatment.