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

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

Authors: Magnus Lindh a; Ingrid Uhnoo b; Joans Blckberg c; Ann-Sofi Duberg d;

Stybjrn Friman e; Bjrn Fischler f; Olof Karlstrm g; Gunnar Norkrans h; Olle

Reichard i; Per Sangfeldt j; Ann Sderstrm k; Anders Snnerborg g; Ola Weiland

g; Rune Wejstl h; Johan Wistrm l

Affiliations: a From the Departments of Infectious Diseases and Department of

Clinical Virology, Sahlgrenska University Hospital, Gteborg, Sweden

b Swedish Medical Products Agency, Uppsala, Sweden

c Department of Infectious Diseases, Lund University, Lund, Sweden

d Department of Infectious Diseases, rebro University Hospital, rebro, Sweden

e Transplantation and Liver Surgery, Sahlgrenska University Hospital, Gteborg,

Sweden

f Departments of Paediatrics, Karolinska University Hospital, Stockholm, Sweden

g Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

h Infectious Diseases, Sahlgrenska University Hospital, Gteborg, Sweden

i Infectious Diseases Clinic, Vsters Hospital, Vsters, Sweden

j Department of Infectious Diseases, Akademiska University Hospital, Uppsala,

Sweden

k Units for Communicable Disease Control, Vstra gtalandsregionen, Gteborg,

Sweden

l Department of Infectious Diseases, University Hospital of Ume, Ume, Sweden

DOI: 10.1080/00365540802154769

Publication Frequency: 12 issues per year

Published in: Scandinavian Journal of Infectious Diseases, Volume 40, Issue 6 &

7 2008 , pages 436 - 450

First Published: 2008

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.