Treatment sequence in adults with HBeAg-positive chronic hepatitis B and compensated liver disease 在成人HBeAg阳性慢性乙型肝炎 和代偿性肝病的治疗序列
Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-positive chronic hepatitis B and compensated liver 24 disease.
Offer tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion after first-line treatment with peginterferon alfa-2a.
Offer entecavir as an alternative second-line treatment to people who cannot tolerate tenofovir disoproxil or if it is contraindicated.
Treatment sequence in adults with HBeAg-negative chronic hepatitis B and compensated liver disease 在成人HBeAg阴性慢性乙型肝炎和代偿性肝脏疾病的治疗序列
Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-negative chronic hepatitis B and compensated liver 4 disease.
Offer tenofovir disoproxil or entecavir as second-line treatment to people with detectable HBV DNA after first-line treatment with peginterferon alfa-2a.
提供48周的聚乙二醇干扰素α-2a干扰素作为一线治疗HBeAg阴性慢性B型肝炎和肝功能代偿疾病的成年人。
提供替诺福韦或恩替卡韦作为第二线治疗后HBV DNA检测的人的第一线治疗与聚乙二醇干扰素α-2a。
Women who are pregnant or breastfeeding 怀孕或哺乳期的妇女
Offer tenofovir disoproxil to women with HBV DNA >107 log10 IU/ml in the 10 third trimester to reduce the risk of transmission of HBV to the baby.
提供替诺福韦妇女HBV DNA>107 LOG10 IU /毫升在10孕晚期,以减少风险的HBV传播给宝宝。 作者: StephenW 时间: 2013-1-18 22:42
1.5 Antiviral treatment
1.5.1 Discuss treatment options, adverse effects and long-term prognosis with the patient before starting treatment.
1.5.2 Offer antiviral treatment to adults aged 30 years and older who have HBV DNA >2000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart.
1.5.3 Offer antiviral treatment to adults younger than 30 years who have HBV DNA >2000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart if there is evidence of necroinflammation or fibrosis on liver biopsy or a transient elastography score >6 kPa.
1.5. Offer antiviral treatment to adults who have HBV DNA >20,000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart regardless of age or the extent of liver disease.
1.5.5 Offer antiviral treatment to adults with cirrhosis regardless of HBeAg status, HBV DNA and ALT levels.
1.5.6 Consider antiviral treatment in adults with HBV DNA >2000 IU/ml and evidence of necroinflammation or fibrosis on liver biopsy.
1.5.7 Peginterferon alfa-2a is recommended as an option for the initial treatment of adults with chronic hepatitis B (HBeAg-positive or HBeAg-negative), within its licensed indications. [This recommendation is from Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B (NICE technology appraisal guidance 96).]
1.5.8 Entecavir, within its marketing authorisation, is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated. [This recommendation is from Entecavir for the treatment of chronic hepatitis B (NICE technology appraisal guidance 153).]
1.5.9 Tenofovir disoproxil, within its marketing authorisation, is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral 8 treatment is indicated. [This recommendation is from Tenofovir disoproxil fumarate for the treatment of hepatitis B (NICE technology appraisal guidance 173).]
1.5.10 Telbivudine is not recommended for the treatment of chronic hepatitis B. [This recommendation is from Telbivudine for the treatment of chronic hepatitis B (NICE technology appraisal guidance 154).]
1.5.11 People currently receiving telbivudine should have the option to continue therapy until they and their clinicians consider it appropriate to stop. [This recommendation is from Telbivudine for the treatment of chronic hepatitis B (NICE technology appraisal guidance 154).]
1.5.12 Adefovir dipivoxil is not recommended for the treatment of chronic hepatitis B.
1.5.13 Offer tenofovir disoproxil or entecavir to people currently receiving adefovir dipivoxil, depending on previous antiviral exposure: offer tenofovir disoproxil to people with a history of lamivudine resistance.
1.5.14 Antiviral treatment should be initiated only by an appropriately qualified healthcare professional with expertise in the management of viral hepatitis. Continuation of therapy under shared-care arrangements with a GP is appropriate. 作者: StephenW 时间: 2013-1-18 23:00
Treatment sequence in adults with HBeAg-positive chronic hepatitis B and compensated liver disease
1.5.15 Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-positive chronic hepatitis B and compensated liver disease.
1.5.16 Stop peginterferon alfa-2a 12 weeks after starting treatment if HBV DNA level has decreased by less than 2 log10 IU/ml and offer second-line treatment in line with recommendations 1.5.17 and 1.5.18.
1.5.17 Offer tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion after first-line treatment with peginterferon alfa-2a.
1.5.18 Offer entecavir as an alternative second-line treatment to people who cannot tolerate tenofovir disoproxil or if it is contraindicated.
1.5.19 In people taking tenofovir disoproxil who have detectable HBV DNA at 48 weeks of treatment and no history of lamivudine resistance, consider adding lamivudine to tenofovir disoproxil. In people with a history of lamivudine resistance, consider adding entecavir to tenofovir disoproxil.
1.5.20 Consider stopping nucleoside or nucleotide analogue treatment 12 months after HBeAg seroconversion in people without cirrhosis.
1.5.21 Do not stop nucleoside or nucleotide analogue treatment 12 months after HBeAg seroconversion in people with cirrhosis.
Treatment sequence in adults with HBeAg-negative chronic hepatitis B and compensated liver disease
1.5.22 Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-negative chronic hepatitis B and compensated liver disease.
1.5.23 Stop peginterferon alfa-2a 12 weeks after starting treatment if HBV DNA level has decreased by less than 2 log10 IU/ml and offer second-line treatment in line with recommendation 1.5.24.
1.5.24 Offer tenofovir disoproxil or entecavir as second-line treatment to people with detectable HBV DNA after first-line treatment with peginterferon alfa-2a.
1.5.25 Consider switching from tenofovir disoproxil to entecavir, or from entecavir to tenofovir disoproxil, as third-line treatment in people who have detectable HBV DNA at 48 weeks of treatment.
1.5.26 Consider stopping nucleoside or nucleotide analogue treatment 12 months after achieving undetectable HBV DNA and HBsAg seroconversion in people without cirrhosis.
1.5.27 Do not stop nucleoside or nucleotide analogue treatment after achieving undetectable HBV DNA and HBsAg seroconversion in patients with cirrhosis.