1) [Ссылки доступны только зарегистрированным пользователям ]
Treatment of the HBV-Infected Patient: When to Start, When to Stop, and When to Change Therapy CME
Emmet B. Keeffe, MD, MACP
The preferred options for the treatment of chronic hepatitis B in 2008 will likely include peginterferon alfa-2a, entecavir, tenofovir, and potentially telbivudine, providing serum HBV DNA is undetectable after 24 weeks of therapy, which predicts the absence or very low rate of resistance at year 1 and year 2 of therapy with this agent.[16,17]
2)[Ссылки доступны только зарегистрированным пользователям ]
Issues in the Long-term Management of Hepatitis B
As mentioned previously, there are currently 6 agents approved by the US FDA for the treatment of chronic hepatitis B: interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, adefovir, entecavir, and telbivudine. Because complete eradication of virus is rarely realized, prolonged antiviral therapy is necessary to sustain viral suppression.
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3)EASL Clinical Practice Guidelines:
Management of chronic hepatitis B
European Association for the Study of the Liver*
Journal of Hepatology 50 (2009) 227–242
4.10. How to monitor treatment and stopping points
4.10.1. Finite therapy with pegylated interferon alpha
In patients treated with pegylated interferon alpha, full blood counts and serum ALT levels should be monitoredmonthly. Serum HBV DNA level should be assessed at weeks 12 and 24 to verify primary response.
_ In HBeAg-positive patients, HBeAg and anti-HBe antibodies should be checked at weeks 24 and 48 and 24 weeks post-treatment. HBe serocon-version together with ALT normalisation and serum HBV DNA below 2000 IU/ml (approximately 10,000 copies/ml), i.e. 3.3 log10 IU/ml, is the desired outcome (A1). Undetectable serum HBV DNA by real-time PCR during follow-up is the optimal outcome since it is associated with a high chance of
HBsAg loss. HBeAg-positive patients who develop HBe seroconversion with pegylated interferon or NUCs require long follow-up because of the possibility of HBe seroreversion or HBeAg-negative chronic hepatitis B. HBsAg should be checked at 6-month intervals after HBe seroconversion if
HBV DNA is undetectable.
Quantitative HBsAg assay is still a research tool.
In case of a primary non-response, i.e. failure to achieve a 1 log10 reduction from baseline at 12 weeks, interferon treatment should be stopped and replaced by a NUC (B1).
_ HBeAg-negative patients should be similarly monitored for efficacy and safety through 48 weeks of treatment. A virological response with HBV DNA <2000 IU/ml (approximately 10,000 copies/ml), i.e. 3.3 log10 IU/ml, is generally associated with remission of the liver disease.
Undetectable HBV DNA in real-time PCR is the ideal desired offtreatment sustained response with a high probability of HBsAg loss in the longer term. HBsAg should be checked at 6-month intervals if HBV DNA is undetectable (B1)..
Лана, распечатайте, отдайте на перевод (здесь мало текста) и аргументируйте при беседе с врачом свою позицию. Хотелось бы услышать максимально близко к тексту и аргументацию леч.врача.
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