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Treatment of chronic hepatitis B infection: An update of Swedish recommendations

Lindh, Magnus; Uhnoo, Ingrid; Bläckberg, Jonas LU ; Duberg, Ann-Sofi; Friman, Styrbjorn; Fischler, Bjorn; Karlstrom, Olof; Norkrans, Gunnar; Reichard, Olle and Sangfeldt, Per, et al. (2008) In Scandinavian Journal of Infectious Diseases 40(6-7). p.436-450
Abstract
The main goal for treatment of chronic hepatitis B is to prevent complications such as liver cirrhosis or hepatocellular carcinoma. Knowledge from population studies of the long-term risk of chronic HBV infection, as well as the recent introduction of pegylated interferon and additional nucleoside analogues has changed the therapeutic situation. Recently, a Swedish expert panel convened to update the national recommendations for treatment. The panel recommends treatment for patients with active HBV infection causing protracted liver inflammation or significant liver fibrosis, verified by liver histology. In general, pegylated interferon alpha-2a is recommended as first-line treatment, in particular for HBeAg-positive patients with HBV... (More)
The main goal for treatment of chronic hepatitis B is to prevent complications such as liver cirrhosis or hepatocellular carcinoma. Knowledge from population studies of the long-term risk of chronic HBV infection, as well as the recent introduction of pegylated interferon and additional nucleoside analogues has changed the therapeutic situation. Recently, a Swedish expert panel convened to update the national recommendations for treatment. The panel recommends treatment for patients with active HBV infection causing protracted liver inflammation or significant liver fibrosis, verified by liver histology. In general, pegylated interferon alpha-2a is recommended as first-line treatment, in particular for HBeAg-positive patients with HBV genotypes A or B. Among nucleoside analogues, entecavir is the first choice and adefovir or tenofovir can be used as alternatives. Lamivudine monotherapy is not recommended due to the high risk of resistance development. Combinations of nucleoside analogues such as tenofovir and lamivudine or emtricitabine are alternatives for patients with non-response or infection with resistant variants, or as first choice for patients with advanced liver disease. Nucleoside analogue treatment should be monitored to detect primary non-response and virological breakthrough. Special recommendations are given for HBV/HIV coinfected patients, immunosuppressed patients, children, and for treatment before and after liver transplantation. The present guideline is translated from Swedish, where it is published on the MPA and RAV websites (www.mpa.se and www.rav.nu.se) including 7 separate papers based on thorough literature search. The complete reference list can be received from the Medical Products Agency upon request. (Less)
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published
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Scandinavian Journal of Infectious Diseases
volume
40
issue
6-7
pages
436 - 450
publisher
Informa Healthcare
external identifiers
  • wos:000257148100001
  • scopus:47349100200
ISSN
1651-1980
DOI
10.1080/00365540802154769
language
English
LU publication?
yes
id
46839986-0fc3-4da1-a697-d11d619d1e5d (old id 1186306)
date added to LUP
2008-09-03 14:41:50
date last changed
2017-04-30 12:32:43
@article{46839986-0fc3-4da1-a697-d11d619d1e5d,
  abstract     = {The main goal for treatment of chronic hepatitis B is to prevent complications such as liver cirrhosis or hepatocellular carcinoma. Knowledge from population studies of the long-term risk of chronic HBV infection, as well as the recent introduction of pegylated interferon and additional nucleoside analogues has changed the therapeutic situation. Recently, a Swedish expert panel convened to update the national recommendations for treatment. The panel recommends treatment for patients with active HBV infection causing protracted liver inflammation or significant liver fibrosis, verified by liver histology. In general, pegylated interferon alpha-2a is recommended as first-line treatment, in particular for HBeAg-positive patients with HBV genotypes A or B. Among nucleoside analogues, entecavir is the first choice and adefovir or tenofovir can be used as alternatives. Lamivudine monotherapy is not recommended due to the high risk of resistance development. Combinations of nucleoside analogues such as tenofovir and lamivudine or emtricitabine are alternatives for patients with non-response or infection with resistant variants, or as first choice for patients with advanced liver disease. Nucleoside analogue treatment should be monitored to detect primary non-response and virological breakthrough. Special recommendations are given for HBV/HIV coinfected patients, immunosuppressed patients, children, and for treatment before and after liver transplantation. The present guideline is translated from Swedish, where it is published on the MPA and RAV websites (www.mpa.se and www.rav.nu.se) including 7 separate papers based on thorough literature search. The complete reference list can be received from the Medical Products Agency upon request.},
  author       = {Lindh, Magnus and Uhnoo, Ingrid and Bläckberg, Jonas and Duberg, Ann-Sofi and Friman, Styrbjorn and Fischler, Bjorn and Karlstrom, Olof and Norkrans, Gunnar and Reichard, Olle and Sangfeldt, Per and Soderstrom, Ann and Sonnerborg, Anders and Weiland, Ola and Wejstal, Rune and Wistrom, Johan},
  issn         = {1651-1980},
  language     = {eng},
  number       = {6-7},
  pages        = {436--450},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Infectious Diseases},
  title        = {Treatment of chronic hepatitis B infection: An update of Swedish recommendations},
  url          = {http://dx.doi.org/10.1080/00365540802154769},
  volume       = {40},
  year         = {2008},
}