英国NICE发行B型肝炎的诊断和管理的指南草案

StephenW

英国NICE(National Institute for Health and Clinical Excellent, 国家健康和临床优秀研究所)发行B型肝炎的诊断和管理的指南草案.

My selected extracts [please see full report]
我个人所选择的摘录[请参阅报告全文]
http://www.nice.org.uk/nicemedia/live/13299/62361/62361.pdf

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.

提供48周的聚乙二醇干扰素α-2a干扰素作为一线治疗HBeAg阳性慢性B型肝炎和肝功能代偿24疾病的成年人。
提供替诺福韦作为二线治疗的人谁不接受第一线与聚乙二醇干扰素α-2a治疗后HBeAg血清学转换。
认购恩替卡韦作为一种替代的二线治疗的人谁不能忍受替诺福韦，或者如果它是禁忌。

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。

StephenW

很简单：没有拉米夫定，替比夫定和阿德福韦

StephenW

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.

StephenW

1.5抗病毒治疗
1.5.1讨论治疗方案，不良反应和长期预后与患者在开始治疗之前。
1.5.2提供抗病毒治疗的成人年龄在30岁及以上的HBV DNA> 2000 IU / ml和ALT异常（≥30的男性和女性≥19），连续2次的测试进行了3个月外。
1.5.3提供抗病毒治疗的成人年龄超过30年的HBV DNA> 2000 IU / ml和ALT异常（≥30的男性和女性≥19），连续2次的测试进行了3个月外，如果有证据的坏死性炎症或纤维化肝组织活检或瞬时弹性成像评分> 6Kpa。
1.5。提供抗病毒治疗的成人有HBV DNA> 20,000 IU / ml和ALT异常（≥30的男性和≥19女性）连续2次的测试进行了3个月外，无论年龄或肝病的程度。
1.5.5提供抗病毒治疗的成人肝硬化不管HBeAg状态，HBV DNA和ALT水平。
1.5.6考虑抗病毒治疗的成人与HBV DNA> 2000 IU / ml和坏死性炎症或纤维化肝组织活检的证据。
1.5.7聚乙二醇干扰素α-2a干扰素被推荐为一个选项的初始治疗成人慢性乙型肝炎（HBeAg阳性或HBeAg阴性），在其授权的迹象。这项建议是从阿德福韦酯与聚乙二醇干扰素α-2a治疗慢性乙型肝炎（NICE技术评估指导96）。]
1.5.8恩替卡韦，在其销售的授权，被推荐用于治疗HBeAg阳性或HBeAg阴性的慢性乙肝抗病毒治疗的人表示作为一个选项。这项建议是由恩替卡韦治疗慢性乙型肝炎（NICE技术评估指导153）。]
1.5.9替诺福韦，在其销售的授权，被推荐用于治疗HBeAg阳性或HBeAg阴性慢性乙型肝炎抗病毒治疗的人表示人作为一个选项。这项建议是由富马酸替诺福韦酯用于治疗B型肝炎（NICE技术评估指导173）。
1.5.10替比夫定不推荐用于治疗慢性乙型肝炎的这项建议是由替比夫定治疗慢性乙型肝炎（NICE技术评估指导154）。
1.5.11的人目前正在接受替比夫定应有权选择继续治疗，直到他们和他们的医生认为这是适当停止。这项建议是由替比夫定治疗慢性乙型肝炎（NICE技术评估指导154）。
1.5.12不推荐用于治疗慢性乙型肝炎阿德福韦酯
1.5.13发售替诺福韦或恩替卡韦的人目前正在接受阿德福韦酯，根据以前的抗病毒药物暴露的人提供替诺福韦，拉米夫定耐药的历史。
1.5.14开始抗病毒治疗应只能由具有适当资格的医疗专业人士的专业知识病毒性肝炎的管理。延续共享的照顾安

StephenW

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.

在成人HBeAg阳性慢性乙型肝炎和代偿性肝脏疾病的治疗序列
1.5.15提供48周的聚乙二醇干扰素α-2a干扰素作为一线治疗HBeAg阳性慢性乙型肝炎患者和代偿性肝脏疾病的成年人。
1.5.16停止聚乙二醇干扰素α-2a干扰素治疗12周后开始，如果HBV DNA水平下降了不到2个log10 IU /毫升，并提供建议1.5.17和1.5.18线与第二线治疗。
1.5.17发售替诺福韦作为二线治疗的人谁不接受第一线与聚乙二醇干扰素α-2a治疗后HBeAg血清学转换。
1.5.18发恩替卡韦作为一种替代的二线治疗的人谁不能忍受替诺福韦，或者如果它是禁忌。
1.5.19检测HBV DNA在48周的拉米夫定耐药性的治疗，也没有历史的人服用替诺福韦，拉米夫定替诺福韦。在人与拉米夫定耐药的历史，可以考虑增加恩替卡韦替诺福韦。
1.5.20考虑停止核苷或核苷酸类似物治疗12个月后HBeAg血清转换的人没有肝硬化。
1.5.21不要停止核苷或核苷酸类似物治疗12个月后HBeAg血清学转换肝硬化的人。

StephenW

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.

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

1.5.22提供为期48周的聚乙二醇干扰素α-2a干扰素作为一线治疗HBeAg阴性慢性乙型肝炎患者和代偿性肝脏疾病在成人的过程中。
1.5.23停止聚乙二醇干扰素α-2a干扰素开始治疗12周后，HBV DNA水平下降了不到2个log10 IU /毫升，并提供第二线治疗建议1.5.24。
1.5.24发售替诺福韦或恩替卡韦作为二线治疗的第一线治疗与聚乙二醇干扰素α-2a后可检测到HBV DNA的人。
1.5.25考虑改用恩替卡韦替诺福韦或恩替卡韦，替诺福韦，作为三线治疗的人谁也检测到HBV DNA在48周的治疗。
1.5.26考虑停止核苷或核苷酸类似物治疗12个月后检测不到HBV DNA和HBsAg血清转换的人没有肝硬化。
1.5.27不要停止核苷或核苷酸类似物治疗后，肝硬化患者检测不到HBV DNA和HBsAg血清转换。