Management of Chronic Hepatitis B

摘要: According to the WHO, approximately 350 million people have chronic hepatitis B. Individuals with B a highly variable and unpredictable clinical course are at risk for developing cirrhosis hepatocellular carcinoma. Lamivudine is only oral antiviral agent approved treatment of patients useful in wide range ongoing viral replication. In compensated liver disease treated 52 weeks multicenter randomized, double-blind studies, lamivudine 100 mg/day inhibited virus (HBV) replication, normalized ALT levels, produced significant reductions hepatic necroinflammatory activity halted progression fibrosis compared placebo. Hepatitis e antigen (HBeAg) seroconversion rates were also increased during drug who continued receive after completion these trials, improvements histology maintained HBeAg proportion duration treatment. Pretreatment levels predictive HBeAgseroconversion. baseline ≥2-fold higher than upper limit normal, significantly those lower values. Data from 2 randomized studies indicate that sequential therapy 8 then plus interferon-α 16 provides no greater benefit monotherapy or weeks. data noncomparative 150 resulted stabilization, Child-Pugh-Turcotte scores loss many decompensated disease. Moreover, some been placed on inactive status transplantation drug. Lamivudine-resistant HBV variants isolated lamivudine. The prevalence increases treatment; however, their long term significance has not established. well tolerated. frequency adverse events placebo recipients was similar pooled analysis trial data. Nonetheless, must be monitored emergence lamivudine-resistant elevated enzyme (ALT flares). series economic models, use predicted reduce cost per case prevented increase mean life expectancy US. Other analyses, which incorporated fixed budget scenario, concluded would number successfully by 2- 3-fold interferon-α, because acquisition costs. conclusion,