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发表于 2004-2-11 11:51
Management of Chronic Hepatitis B:
A New Treatment Algorithm from a Panel of US Experts
Coauthors:
Emmet B. Keeffe, Douglas T. Dieterich, Steve-Huy Han, Ira M. Jacobson,
Paul Martin, Eugene R. Schiff, Hillel Tobias, and Teresa L. Wright.
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Chronic hepatitis B is an important public health problem in the United States and worldwide. With three FDA-approved therapies available in the US for chronic HBV infection, expert guidance is required to provide a blueprint for treatment and management of the disease.
To this end, a panel of US hepatologists (see 揷oauthors?above) has created a treatment algorithm for chronic hepatitis B virus (HBV) infection. Their work appears in the current issue of Clinical Gastroenterology and Hepatology (February 2004).
The new algorithm is based on new developments in the understanding of the virology of HBV, the availability of more sensitive molecular diagnostic testing, and an examination of the advantages and disadvantages of currently approved therapies.
This algorithm is based on available evidence, but where data are lacking, the panel relied on clinical experience and consensus expert opinion.
Serum HBV DNA can be detected at levels as low as 100?000 copies/mL by using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance.
Therapies
The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest level possible. The threshold level of HBV DNA for determination of candidacy for therapy is >105 copies/mL for patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. A lower serum HBV DNA threshold is appropriate for patients with HBeAg-negative chronic hepatitis B and those with decompensated cirrhosis, and the panel recommends thresholds of 104 copies/mL and 103 copies/mL, respectively.
Intron A (interferon alfa-2b), Epivir-HBV (lamivudine), and Hepsera (adefovir dipivoxil) are approved as initial therapy for chronic hepatitis B and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost.
Studies are under way to explore the safety and efficacy of combination therapy, which may prove to be more effective than monotherapy in suppressing viral replication, and may decrease or delay the incidence of drug resistance.
The aim of the current article is to develop a practical and comprehensive algorithm for the diagnosis, treatment, and monitoring of patients with chronic HBV infection in the United States.
The panel analyzed existing data on available therapies, as well as published guidelines. When possible, the panel抯 recommendations are based solidly on evidence, but where data are lacking, the panel relied on their own clinical experience and expert opinion.
The algorithm aims to assist treating physicians in answering the practical questions of what tests to order and how to interpret them, which patients to treat, when and how long to treat, what the available treatment options are, and how to monitor patients.
HIV and Hepatitis.com urges readers to review the complete article on the new treatment algorithm published in Clinical Gastroenterology and Hepatology.
Following are five key Tables from the algorithm article that summarize the panel抯 conclusions and recommendations regarding management of chronic hepatitis C in various HBV patient populations.
The meeting at which the algorithm was developed was supported by an unrestricted educational grant from Gilead Sciences.
02/06/04
Reference
E B Keeffe and others. A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States. Clinical Gastroenterology and Hepatology 2: 87-106. 2004.
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