hepatitis b an update on treatment
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www.drsarma.in. HEPATITIS B AN UPDATE ON TREATMENT. Dr. R V S N Sarma MD MSc (Canada) FIMSA Consultant Physician and Cardio Metabolic Specialist. Who should be treated ?. When to treat in HBV course ? What is the treatment ?. Goal of Antiviral Therapy. - PowerPoint PPT PresentationTRANSCRIPT
1. Sustained suppression of HBV replication
Decrease in serum HBV DNA to <105 copies/ml
Seroconversion HBeAg to anti-HBe; HBsAg to anti-HBs
2. Remission of liver disease; Normalization of serum
ALT levels
Decreased necro-inflammation in liver
3. Improvement in clinical outcome; Decreased risks of
developing cirrhosis, liver failure and HCC;
4. Increased survival
Patients who have
• Acute liver failure due to HBV
• ALT of >2 x UNL and or HBV DNA > 20,000 IU/ml
• Cirrhosis and clinical complications
• Cirrhosis or advanced fibrosis & HBV DNA in serum
• Reactivation of Chronic HBV after chemotherapy or immuno-suppression
• Infants born to women who are HBsAg-positive
• The immune-active phase who do not have advanced fibrosis or cirrhosis
Patients with
• Chronic hepatitis B in the immune-tolerant phase (with high levels of serum HBV DNA but normal serum ALT levels or little activity on liver biopsy)
• Patients in the inactive carrier or low replicative phase (with low levels of or no detectable HBV DNA in serum and normal serum ALT levels)
• Patients who have latent HBV infection (HBV DNA without HBsAg)
• High baseline ALT level
• Low Baseline HBV DNA level
• Mild-to-moderate histological activity
• Mild to Moderate stage Liver Dysfunction
• Genotype of the HBV – (A>B>C>D)
• Baseline HBeAg positivity (wild virus)
• Genetic barrier to resistance - Lamivudine, Telbivudine and to a lesser degree, Adefovir
• Persistently elevated HBV DNA
• Persistently elevated ALT (SGPT)
• HBV genotype C infection
• Male Gender, Older age
• Family history of HCC
• Co-infection with HCV or HIV or HDV
Obtain Baseline testsObtain Baseline tests
HBV DNA, ALTHBV Serology panel
Obtain Baseline testsObtain Baseline tests
HBV DNA, ALTHBV Serology panel
Endocrine
Hypothyroidism
Hyperthyroidism
Dermatologic
Rash, Dry skin, Pruritus
Thinning of Hair
Gastrointestinal
Anorexia, Nausea, Weight loss
Systemic
Fever (low grade), Fatigue
Myalgia and or Arthralgia
Mood Disturbances
Depression
Irritability, Insomnia
Hematologic
Neutropenia, Anemia
Thrombocytopenia
105 copies/ml(20,000 IU/ml)
• Emtricitabine
• Clevudine (l-FMAU)
• Therapeutic vaccines