Management of patients with hepatitis B in special populations

The development of effective nucleos(t)ide analogs(NAs)against hepatitis B virus(HBV)has improved the outcome of patients with chronic hepatitis B(CHB).This review updates issues related to the management of CHB patients included in special populations.Entecavir(ETV)and tenofovir(TDF)represent the c...

Full description

Saved in:
Bibliographic Details
Published in:World journal of gastroenterology : WJG 2015-02, Vol.21 (6), p.1738-1748
Main Authors: Cholongitas, Evangelos, Tziomalos, Konstantinos, Pipili, Chrysoula
Format: Article
Language:English
Subjects:
Age Factors
Antiviral Agents - therapeutic use
B
Antiviral
Comorbidity
Female
Hepatitis
Hepatitis B virus - drug effects
Hepatitis B virus - pathogenicity
Hepatitis B, Chronic - diagnosis
Hepatitis B, Chronic - drug therapy
Hepatitis B, Chronic - epidemiology
Humans
Immunocompromised Host
Immunoglobulins - therapeutic use
Kidney Transplantation - adverse effects
Liver Transplantation - adverse effects
Male
Patient Selection
Pregnancy
Review
Risk Assessment
Risk Factors
therapy
Tenofovir
Entecavir
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The development of effective nucleos(t)ide analogs(NAs)against hepatitis B virus(HBV)has improved the outcome of patients with chronic hepatitis B(CHB).This review updates issues related to the management of CHB patients included in special populations.Entecavir(ETV)and tenofovir(TDF)represent the currently recommended first-line NAs in patients with HBV decompensated cirrhosis.The combination of HBV immunoglobulin(usually for a finite duration)and NA is considered the standard of care for prophylaxis against HBV recurrence after liver transplantation.TDF is the best choice for hemodialysis patients and in patients with chronic kidney disease with nucleoside resistance.ETV and telbivudine are the preferred options in na?ve renal transplant recipients and with low viremia levels,respectively.All hepatitis B surface antigen(HBs Ag)-positive candidates should be treated with NAs before renal transplantation to achieve undetectable HBV DNA at the time of transplantation.Conventional interferon or NAs can also be used in children,on the basis of well-established therapeutic indication.Pregnant women at high risk of perinatal transmission could be treated with lamivudine,telbivudine or TDF in the last trimester of pregnancy.HBs Ag-positive patients under immunosuppression should receive NA preemptively(regardless of HBV DNA levels)up to 12 mo after its cessation.In HBs Ag negative,anti-HBc positive patients under immunosuppression,further studies are needed to form a final conclusion;however,it seems that anti-HBV prophylaxis is justified in such patients with hematological diseases and/or for those receiving rituximab-containing regimens,regardless of their antiHBs or serum HBV DNA status.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v21.i6.1738