Vnitr Lek 2005, 51(10):1131-1137

Diagnosis and treatment of chronic hepatitis B

P. Husa^1,*, S. Plíšek², J. Šperl³, P. Urbánek⁴, J. Galský⁵, P. Hůlek⁶, P. Kümpel⁷, V. Němeček⁸, M. Volfová⁹

¹ Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Petr Husa, CSc.

² Infekční klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta doc. MUDr. Václav Dostál

³ Klinika hepatogastroenterologie IKEM, Praha, přednosta doc. MUDr. Julius Špičák, CSc.

⁴ IV. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta doc. MUDr. Aleš Žák, DrSc.

⁵ Infekční oddělení nemocnice, Mělník, přednosta prim. MUDr. Jan Galský

⁶ II. interní klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.

⁷ Infekční oddělení Slezské nemocnice, Opava, přednosta prim. MUDr. Petr Kümpel

⁸ Národní referenční laboratoř pro virové hepatitidy Státního zdravotního ústavu, Praha, ředitel MUDr. Jaroslav Volf, Ph.D.

⁹ Hepato-Gastroenterologie HK s r.o., Hradec Králové

Chronic hepatitis B is one of the most frequent infectious diseases on the world scale. Its prevalence in the Czech Republic is 0.56 %. Anti-virus treatment of chronic hepatitis B clearly improves the quality of life and is undoubtedly less expensive than the treatment of complications of advanced hepatic cirrhosis or hepatocellular carcinoma, provided the indication criteria and standard therapeutic procedures are applied. Pegylated interferon (IFN) α-2a represents the most effective treatment currently available and should be therefore a first choice remedy in the initial therapy of both HBeAg positive and negative chronic hepatitis B, unless contraindications to IFN α treatment exist. Conventional ("standard" or "classic") IFN α can also be used, but clinical studies have shown that it is less effective than IFN α-2a. The main advantage of interferons as compared with other commercially available drugs is a relatively shorter and better defined period of treatment and a high probability of sustaining the achieved virus replication suppression and seroconversion of HBeAg/anti-Hbe (in originally HbeAg positive patients). In case (both pegylated and conventional) IFN α is contraindicated, ineffective or poorly tolerated, administration of lamivudine (LAM) is correct. LAM treatment is very often accompanied by the formation of HBV mutants which are partly or entirely resistant to lamivudin. In case of formation of a virus mutant resistant to lamivudin, the administration of adefovir dipivoxil or pegylated IFN α -2a is indicated. Combined therapy by lamivudine and IFN α (pegylated or conventional) is not more efficient than interferon monotherapy.

Keywords: chronic hepatitis B; pegylated interferon α-2a; interferon (IFN) α; lamivudin; adefovir dipivoxil

Received: August 4, 2005; Published: October 1, 2005  Show citation