标题: CCO: Management of Hepatitis B Infection [打印本页] 作者: liver411 时间: 2012-2-8 12:11 标题: CCO: Management of Hepatitis B Infection
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作者: StephenW 时间: 2012-2-8 12:34
本帖最后由 StephenW 于 2012-2-8 12:34 编辑
Management of Acute Hepatitis B Virus Infection
The symptoms and course of acute hepatitis B virus (HBV) infection depends strongly on the age at the time of infection.[Liaw 2009a] Acute hepatitis B is usually subclinical in neonates, whereas up to one third of adults may experience symptoms.[McMahon 1985] Early symptoms include influenzalike symptoms, gastrointestinal symptoms, and fatigue. When these symptoms subside, darkening of urine, pale stool, and jaundice may be observed. Physical examination findings are nonspecific, and may include mild enlargement and slight tenderness of the liver, and mild splenomegaly.
The diagnosis of acute HBV infection is based on the presence of hepatitis B surface antigen (HBsAg) and IgM-antibodies to hepatitis B core antigen (IgM-anti-HBc) in serum.[Lok 2009] During the initial phase, patients may also be positive for hepatitis B e antigen (HBeAg), and high levels of HBV DNA may be detected. In patients with self-limiting disease, antibodies to HBsAg (anti-HBs) develop, but there may be a window period where both anti-HBs and HBsAg are negative, leaving anti-HBc the only detectable marker. If HBsAg is not cleared from serum, chronic hepatitis B infection is diagnosed after documented positivity for 6 months.[Lok 2009; EASL 2009]
Treatment is generally not indicated for acute HBV infection because most patients (> 95%) recover spontaneously.[Liaw 2009a] Therefore, management of acute hepatitis B infection is typically supportive, and close monitoring may help early identification of fulminant hepatitis with liver failure. However, treatment is indicated for patients with fulminant hepatitis B according to the American Association for the Study of Liver Diseases (AASLD) (Management Guidelines)[Lok 2009] and the European Association for the Study of the Liver (EASL) (Management Guidelines).[EASL 2009] For such patients, the AASLD guidelines recommend lamivudine or telbivudine if the duration of treatment is expected to be short,[Lok 2009] and the EASL guidelines state that lamivudine may be used.[EASL 2009] According to AASLD, if the duration of therapy is expected to be long term, entecavir is preferred due to the risks of resistance associated with lamivudine and telbivudine therapy.[Lok 2009] These recommendations are based largely on studies that show that, although lamivudine therapy does not appear to increase the probability of HBsAg clearance,[Yu 2010; Kumar 2007] treatment reduces mortality in patients with severe acute hepatitis B.[Yu 2010] Indeed, in one study of 80 patients with acute HBV infection receiving either lamivudine or no therapy, mortality was significantly higher in the control group at 25.0% vs the lamivudine group at 7.5% (P = .034).[Yu 2010] Interferon therapy is contraindicated in patients with acute HBV infection because of the high rate of adverse effects and the risk of worsening hepatitis.[Lok 2009; EASL 2009] Tenofovir is not an optimal treatment choice due to its potential for nephrotoxicity. Treatment of acute HBV infection should be continued until HBsAg clearance.[Lok 2009]
Figure 1. Treatment outcomes at 1 year: HBV DNA undetectability (1A) and HBeAg seroconversion (1B) in HBeAg-positive patients and HBV DNA undetectability (1C) in HBeAg-negative patients. Studies were not head-to-head comparisons.图1。结果治疗1年时,HBV DNA不可检测(1A)和HBeAg血清转换的HBeAg阳性患者和HBeAg阴性患者HBV DNA的不可检测(1C)(1B)。研究没有头,头比较。
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作者: StephenW 时间: 2012-2-8 23:05
Figure 2. Rates of confirmed antiviral resistance.图2。证实抗病毒药物耐药率