Hepatitis B virus treatment: Which patients require immediate treatment

Perrillo, Robert P.

doi:10.1002/cld.140

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Tenofovir is preferred for the treatment of decompensated cirrhosis because of greater antiviral potency and a high genetic barrier to resistance. [ 4 ] In this present study, tenofovir resulted in HBV-DNA suppression is 91.7% at 90 days. There are reports that tenofovir significantly reduced HBV-DNA level from baseline 6.64 log to 4.07 ( P < 0.05) at day 15 and 3.04 at day 90 ( P < 0.05).…”

Section: Discussionsupporting

confidence: 51%

Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure

Manik

Malakar

Noor-E-Alam³

et al. 2021

Journal of Family Medicine and Primary Care

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Introduction: HBV is major health problem globally due to complications, including ACLF, cirrhosis and hepa¬tocellular carcinoma. ACLF due to exacerbation of CHB is associate with 30%-70% mortality. Reduction of HBV-DNA is therefore a target of therapy in ACLF-B. Methods: Patients with spontaneous reactivation of HBV [(ALT >5×ULN or >2× baseline) and HBV-DNA >20,000 IU/ml] were randomized to Tenofovir mono therapy (300 mg/day) or Tenofovir plus Telbivudine (600 mg/day) dual therapy with standard care. Clinical and biochemical parameters were evaluated at baseline, 1 week, 4 weeks and at 3 months. Virological evaluation was done at baseline and at 3 months. Primary end points were reduction of HBV-DNA and resolution of ascites, as applied. Secondary end point was reduction of liver related complications, therapy related adverse effects and survival at 3 months. Results: 27 patients were enrolled. 15 received mono therapy with Tenofovir and 12 received dual therapy (Tenofovir plus Telbivudine). Baseline parameters in 2 groups had no significant difference. In both groups there was significant improvement of S. bilirubin, ALT, INR, CTP score and MELD score. Only MELD score showed significant improvement in patient with dual therapy at 3 months in comparison to mono therapy. 11 patients on Tenofovir mono therapy (n=15) showed undetected HBV-DNA (91.7%) at 3 months and one patient had detectable HBV-DNA (<2,000 IU/ml). 10 patients on dual therapy (n=12) had undetectable HBV-DNA (100%). Ascites resolved in 3 patients in both groups. Patients receiving dual therapy showed significant improvement in AKI on follow up compared to those on Tenofovir mono therapy. Among 5 deaths, 3 received mono therapy with Tenofovir and 2 dual therapy. Predictors of mortality had high S. bilirubin, HBV-DNA, MELD score and CTP score. Conclusion: In spontaneous reactivation of HBV presenting as ACLF, combination of Telbivudine plus Tenofovir is safer with less nephrotoxicity and better outcomes.

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Section: Discussionsupporting

confidence: 51%

Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure

Manik

Malakar

Noor-E-Alam³

et al. 2021

Journal of Family Medicine and Primary Care

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“…Diagnosis of ACLF is made on the basis of APASL criteria; -Acute hepatic insult manifesting as Jaundice (serum bilirubin ≥5 mg/dl) and coagulopathy (INR ≥1.5) complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease‖ [1]. To establish this criteria patients history, examination and laboratory assessment Entecavir and tenofovir are currently preferred for the treatment of decompensated cirrhosis because of greater antiviral potency and a high genetic barrier to resistance [21]. In a multinational study, 191 patients with decompensated cirrhosis (mean CTP score 8.8, Model for End-Stage Liver Disease [MELD] score 17.1) were treated with entecavir or adefovir for up to 96 weeks [22].…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Serum Bilirubin, CTP and Meld Score in Patients with HBV-ACLF

Hossain¹,

Mahtab²,

Rahman³

2020

SJAMS

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Recomendaciones en el tratamiento actual de la infección crónica por el virus de la hepatitis B

Escandón-Felizzola

2020

Hepatología

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La infección crónica por el virus de la hepatitis B (VHB) se considera un problema de salud pública mundial. Se estima que al menos dos mil millones de personas han estado expuestas al VHB, y a pesar de una vacuna efectiva, 300 millones de personas están infectadas crónicamente a nivel mundial. Aunque el virus no es directamente citopático, la infección puede desencadenar cirrosis hepática y aun, carcinoma hepatocelular (CHC). El ADN circular cerrado covalentemente (ADNccc) en el núcleo de los hepatocitos y la incapacidad del sistema inmunitario para eliminar la infección crónica por el virus son los mecanismos más importantes de la infección por VHB. Las diferentes entidades, como la Asociación Europea para el Estudio del Hígado (EASL) y la Asociación Americana para el Estudio de las Enfermedades Hepáticas (AASLD), ponen a disposición las pautas para el manejo de esta enfermedad. A pesar de los avances en el tratamiento de la infección crónica por el VHB, en particular con el desarrollo de los análogos de los nucleótidos/nucleósidos, quedan aún muchos interrogantes. Las investigaciones continúan para el desarrollo de nuevas opciones de tratamiento enfocadas principalmente en evitar que la suspensión de la terapia conlleve a un incremento de la carga viral, con el consecuente aumento del riesgo de progresión de la enfermedad hepática, y un eventual CHC.

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Hepatitis B virus treatment: Which patients require immediate treatment

Cited by 3 publications

References 15 publications

Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure

Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure

A Comparison of Serum Bilirubin, CTP and Meld Score in Patients with HBV-ACLF

Recomendaciones en el tratamiento actual de la infección crónica por el virus de la hepatitis B

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