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==Progress==
==Progress==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Recommended Treatment of Chronic Hepatitis B'''''
! style="background: #4479BA; width: 4%;" | {{fontcolor|#FFF|HBeAg}}
! style="background: #4479BA; width: 17%;" | {{fontcolor|#FFF|ALT}}
! style="background: #4479BA; width: 16%;" | {{fontcolor|#FFF|HBV DNA}}
! style="background: #4479BA; width: 63%;" | {{fontcolor|#FFF|Treatment Regimen}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+'''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Low efficacy with present treatment
*Observe: treatment should be considered as ALT rises
*Biopsy should be considered in adults >40years, when:
:*Persistence of an elevated ALT: [Normal;<2xUpper Limit of Normal]
:*Family history of hepatocellular carcinoma
*Treatment should be considered when:
:*HBV DNA > 20,000 IU/mL
:*Signs of inflammation (moderate to severe) or fibrosis on biopsy
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+'''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Observation for 3 to 6 months. Treatment should be started if no spontaneous HBeAg loss
*If compensated, liver biopsy should be considered prior to treatment
*If patient is jaundiced or decompensated, start immediate treatment
*Initial therapy may include:
:*IFNα/pegIFNα
:*Lamivudine
:*Adefovir
:*Entecavir
:*Tenefovir
:*Telbivudine
*Adefovir plays a minor role due to increased resistance rate after 1 year, and weak antiviral activity
*Lamivudine and telbivudine play a minor role due to increased resistance rate
*Treatment goal - seroconversion with production of anti-HBe to HBeAg
*Treatment duration:
:*IFN-α - 16 weeks
:*PegIFN-α - 48 weeks
:*Lamivudine or adefovir or entecavir or telbivudine or tenofovir disoproxil fumarate - >1 year; treatment should be continued >6 months after HBeAg seroconversion
:*Tenofovir disoproxil fumarate or entecavir for: absence of response to IFN-α; or when IFN-α is contraindicated
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''†
| style="padding: 5px 5px; background: #F5F5F5;" |
*Initial therapy may include:
:*IFN-α/PegIFN-α
:*Lamivudine
:*Adefovir
:*Entecavir
:*Tenofovir disoproxil fumarate
:*Telbivudine
*Lamivudine and telbivudine play a minor role due to increased resistance rate
*Adefovir plays a minor role due to increased resistance rate after 1 year, and weak antiviral activity
*Treatment end-point not defined
*Treatment duration:
:*IFN-α/PegIFN-α - 1 year
:*Lamivudine or adefovir or entecavir or telbivudine or tenofovir disoproxil fumarate - > 1 year
:*Tenofovir disoproxil fumarate or entecavir for: absence of response to IFN-α; or when IFN-α is contraindicated
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''[1; >2] x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*If signs of necroinflammation (moderate to severe) or fibrosis on liver biopsy - consider liver biopsy and treatment
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤ Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤2,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Observation. Treatment should be started when: ALT or HBV DNA rise
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+/-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''Cirrhosis''
| style="padding: 5px 5px; background: #F5F5F5;" |''Traceable''
| style="padding: 5px 5px; background: #F5F5F5;" |
*If compensated:
:*If HBV DNA >2,000 IU/mL - Initial therapy may include
::*Lamivudine
::*Adefovir
::*Entecavir
::*Telbivudine
::*Tenofovir disoproxil fumarate
:*Lamivudine and telbivudine play a minor role due to increased resistance rate
:*Adefovir plays a minor role due to increased resistance rate after 1 year, and weak antiviral activity
:*If HBV DNA <2,000 IU/mL - Treatment should be considered if elevated ALT
*If decompensated - Treatment should be coordinated with transplant center:
:*Lamivudine (or telbivudine) + adefovir or tenofovir disoproxil fumarate or entecavir(prefered)
:*Referal for liver transplant
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+/-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''Cirrhosis''
| style="padding: 5px 5px; background: #F5F5F5;" |''Untraceable''
| style="padding: 5px 5px; background: #F5F5F5;" |
*If compensated - observation
*If decompensated - indication fro liver transplant
|-
|}
===Antiviral Medications===
===Antiviral Medications===
There are three types of treatment groups:
There are three types of treatment groups:

Revision as of 01:46, 1 August 2014

Progress

Antiviral Medications

There are three types of treatment groups:

  1. Interferon (IFN)
  2. Nucleoside analogs
  3. Nucleotide analogs

First Line agents

Entecavir (ETV)
  • An anti-HBV nucleoside analog
  • A 94% clearance rate after 5 years of treatment is observed in HBeAg positive patients.[1]
  • A 90% clearance rate after 48 weeks of treatment is observed in HBeAg negative patients.[2]
  • A necroinflammation improvement of 96% and fibrosis improvement of 88% is seen after a treatment for 6 years.[1]
Tenofovir (TDF)
  • An anti-HBV nucleotide analog
  • A 68% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg positive patients.[3]
  • A 84% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg negative patients.
Interferons
  • Antiviral and antiproliferative glycoprotein.
  • No antiviral resistance have been noted
  • Best results noted with genotype A or B who are HBeAg positive.

Second line agents

Telbivudine (LDT)
  • Nucleoside analog
  • Worse resistance than first line agents and not indicated if resistance to other nucleoside analogs are noted.
Adefovir (ADV)
  • Nucleotide analog
  • Worse resistance than first line agents
  • Used in cases of nucleotide analog resistance.
Lamivudine

Pathogenesis

Treatment

When listeric meningitis occurs, the overall mortality may reach 70%; from septicemia 50%, from perinatal/neonatal infections greater than 80%. In infections during pregnancy, the mother usually survives. Reports of successful treatment with parenteral penicillin or ampicillin exist. Trimethoprim-sulfamethoxazole has been shown effective in patients allergic to penicillin.

Bacteriophage treatments have been developed by several companies. EBI Food Safety and Intralytix both have products suitable for treatment of the bacteria. The FDA of the United States approved a cocktail of six bacteriophages from Intralytix, and a one type phage product from EBI Food Safety designed to kill the bacteria L. monocytogenes. Uses would potentially include spraying it on fruits and ready-to-eat meat such as sliced ham and turkey.

Table

Disease Findings
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  1. ↑ 1.0 1.1 "Chronic Hepatitis B: Integrating Long-Term Treatment Data and Strategies to Improve Outcomes in Clinical Practice".
  2. ↑ Lai, CL.; Shouval, D.; Lok, AS.; Chang, TT.; Cheinquer, H.; Goodman, Z.; DeHertogh, D.; Wilber, R.; Zink, RC. (2006). "Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B.". N Engl J Med. 354 (10): 1011–20. doi:10.1056/NEJMoa051287. PMID 16525138. Unknown parameter |month= ignored (help)
  3. ↑ "http://jid.oxfordjournals.org/content/204/3/415.full". External link in |title= (help)
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