tailieunhanh - hepatology 2010_part4

Tiêu chuẩn điều trị cho nhiễm virus viêm gan B Người ta có thể chọn để điều trị với PEG-IFN một để tạo ra một kiểm soát dài hạn bằng cách điều trị hữu hạn hoặc nucleos (t) tương tự ide để ức chế sự sao chép HBV lâu dài (hình 3). | Standard therapy for hepatitis B virus infection How to treat One can choose either to treat with PEG-IFN a in order to induce a long-term control by finite treatment or with nucleos t ide analogues to inhibit HBV replication longterm Figure 3 . At first interferon therapy should be evaluated. However if a patient does not fulfil the criteria for PEG-IFN a has contraindications or is intolerant long-term therapy with nucleos t ide analogues is recommended. If a nucleos t ide analogue is chosen several parameters have to be considered prior to therapy the antiviral efficacy of the drug the durability of response the resistance barrier and the stage of liver disease. If the initial viral load is low and liver cirrhosis has been excluded any approved drug may be used. The use of LAM however should be restricted to patients with mild fibrosis and HBV DNA levels 105 copies ml. For patients with high-level HBV replication 109 copies ml only drugs with a high genetic barrier should be used . ETV or TDF see Table 4 . Drug Advantage Disadvantage Recommendation Lamivudine LAM - low treatment costs - oral solution available for individual dosage in case of renal impairment - high risk of resistance in long-term monotherapy - cross-resistance to ETV and LdT - use as first-line therapy only in selected patients with low viral load - prevention of exacerbation in HBsAg HBV DNA - patients with immunosuppression - pre-emptive therapy in case of HBsAg negative anti-HBc positive patients with immunosuppression Adefovir dipivoxil ADV - a lot of experience in combination with LAM - no cross-resistance to LAM - moderate antiviral activity - primary non-response in 10-20 of cases - slow viral kinetics during therapy - risk of viral resistance in long-term monotherapy - nephrotoxicity - not to use as first-line therapy Telbivudine LdT - high antiviral efficacy - potentially no cross-resistance to entecavir as potential concerns - moderate risk for viral resistance in long-term .