Professional Documents
Culture Documents
hepatitis B ไทย
hepatitis B ไทย
hepatitis B ไทย
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99
Vol. 10 No.3
1. Immunomodulators
- Conventional interferon (intron A)
5-10 IU 3
24
- Pegylated interferon a -2a (pegasys) 180 microgram pegylated interferon
a -2b (peg-intron) 1.5 microgram
1 48
- Thymosis a 1.6 mg
2 48
2. nucleoside lamivudine
(zeffix), entecavir (baraclude), telbivudine (sebivo)
3. nucleotide adefovir
(Hepsera), tenofovir (Viread)
nucleoside
nucleotide
1 HBeAg
HBeAg HBV DNA
60 IU/ml 2 6
HBeAg
HBsAg HBV
DNA 3 6
IJM
1. (HBsAg positive) inactive
chronic hepatitis B infection (HBV carrier)
2.
serum ALT
1.5 5
500 IU/L 2
3
ALT chronic hepatitis B
3.
serum ALT 500 2,000
IU/L acute viral hepatitis
chronic hepatitis B acute flare viral
reactivation
4.
decompensation liver cirrhosis hepatitis B
5.
HIV chemotherapy
IJM
Vol. 10 No.3
No treatment
Interferon (IFN)
Pegylated IFN
Lamivudine (100 mg)
Adefovir (10 mg)
Tenofovir (300 mg)
Telbivudine (600 mg)
Entecavir (0.5 mg)
21%
3.2%
60%
26%
22%
0%
67%
22%
21%
2%
2
viral mutation
genetic resistance barrier tenofovir
entecavir
lamivudine telbivudine adefovir
100
10 3 - 2554
6-12 1.5
.
1 HBeAg +
1. HBeAg +
HBeAg Positive
Advanced liver fibrosis
or liver cirrhosis *
Yes
No
DNA > 20,000 IU/ml
No
Yes
No treatment
Monitor DNA 6-12
No
Consider treatment
>2 ULN
1.5 2 ULN
Liver biopsy
Vol. 10 No.3
No
Yes
IJM
No treatment
Monitor ALT, HBeAg,
DNA 3-6
Significant pathology **
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101
negative
HBeAg negative
2.
HBeAg
HBeAg Negative
DNA > 2,000 IU/ml
ALT Normal
Liver biopsy
No treatment
ALT , HBeAg,
HBV-DNA 6-12
No treatment
6-12
Consider
treatment
Significant pathology
No
Yes
Vol. 10 No.3
3.
IJM
Liver status
No cirrhosis
Decompensate / cirrhosis
Neutropenia
Yes
Consider Nucleotide Nucleoside
102
10 3 - 2554
No
Consider IFN Peg IFN
HbeAg positive 6-12
nucleotide nucleoside HBeAg negative 12
IFNPegIFN
Peg IFN
CBC
2
IFN
ALTadefovir
tenofovir
1-26-12
4-6
thyroid
function
test
HBV
6 HbeAg positive
6-12
HBeAg
12
DNA
3 negative
IFN ALT HBV DNA
adefovir
CBC
tenofovir
Peg IFN
ALT
2
DNA
31-2
ALT
HBV
nucleoside nucleotide
thyroid
IFN
nucleoside
nucleotide
4-6
IFN
test
HBV
function
DNA 6
4.
nucleoside
analogues
4
nucleotide
nucleotide
nucleoside
analogues
Liver cirrhosis
No liver cirrhosis
IJM
Continue treatment
6
cross
resistance* 3
Vol. 10 No.3
10 3 - 2554
103
IJM
Vol. 10 No.3
.
2
1. Acute hepatitis B
1-3
jaundice
1-2
95-99%
seroconversion HBsAg + HBsAb +
HBsAg lamivudine 100 mg/
HBV DNA bilirubin
ALT
Acute hepatitis B
104
10 3 - 2554
HBsAg +
Check DNA
Start antiviral
- Lamivudine DNA < 200
IU/ml
- Entecavir tenofovir
DNA > 2,000 IU/ml
Follow ALT, DNA
6-12
chemotherapy
HBsAg
Anti HBc +
Anti HBs HBV vaccination 1dose
HBsAg
Anti HBc +
Anti HBs +
HBsAg
Anti HBc Anti HBs -
Normal ALT
HBV vaccination
Elevate ALT
Anti HBs +
Anti HBs -
No treatment
HBV DNA +
No treatment
HBV DNA -
HBV DNA
Start Anti-viral
HBV DNA +
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105
Vol. 10 No.3
HBV
reactivation
lamivudine telbivudine
HBV
reactivation
tenofovir
entecavir
Fulminant liver failure
Fulmi-
nant liver failure
.
1.
chemotherapy
immunosupressive
1. chemotherapy immunosu- agents 1. HIV
pressive agents2. lamivudine HIV antiretroviral agent (CD4
2. lamivudine ) HBV ad
efovir telbivudine cross
3. acute liver failure resistance lamivudine tenofovir
liver transplantation HIV CD4
200 cells/ml significant liver fibrosis
cirrhosis 2 lamivudine
. decompensated tenofovir anti-retroviral agents
cirrhosis IFN Peg-IFN 3 HBV DNA 400 copies/ml
IJM
reactivation HBV
3.
IFN peg-IFN lamivudine telbivudine
( 2)
2 anti-HBV
Lamivudine
Telbivudine
.
CCr (ml/min)
Maintenance (mg)
30 50
15 30
5 15
<5
100
100
35
35
50
25
15
10
>50
600
600
30 49
600
600 2
<30
600
600 3
6
<5
600
600 4
First trimester
IJM
Vol. 10 No.3
6. HBV
4.
6
Vaccination
Infant receive vaccination at birth
lamivudine, tenofovir, telbivudine 32
6 HBV
106
10 3 - 2554
IJM
Vol. 10 No.3
1.
2552 :
. http://www.liversocietythailand.
org
2. APASL Guidelines for HBV management
2008. www.apasl.info/guidelinesHBVhtml.
3. AASLD Practical Guideline : Chronic hepatitis
B update 2009. Hepatology 2009;50(3):1-35.
4. Adhish S, Rajesh K, Sajid J, Wright VK.
Chronic HBV with pregnancy : Reactivation
flare causing fulminant hepatic failure. Ann
Hepatol 2011;10(2):233-6.
5. Buti M, Brosa M, Casado MA, Rueda M,
Esteban R. Modeling the cost-effectiveness
of different oral antiviral therapies in patients
with chronic hepatitis B. Journal of Hepatology
2009;51:640-6.
6. Bruno R, Dider S. The difficulties of managing severe hepatitis B virus reactivation. Liver
international 2011:104-10.
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