There is no specific therapy for HAV infection. Supportive therapy to maintain fluid and caloric intake is usually sufficient, and hospitalization is rarely required. Please see the chapter on Prevention for further guidance.
HEPATITIS B
Management of acute hepatitis B consists of observation and follow-up testing. It is prudent to reassess the hepatitis B serologic profile every 1 to 3 months until the acute infection resolves.
Acute hepatitis B may rarely cause severe illness with impaired liver function (fulminant hepatitis) that should be evaluated for liver transplantation and antiviral treatment.
The goal of therapy for chronic hepatitis B is to suppress viral replication, to mitigate hepatic inflammation, and to prevent or slow the progression to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
A number of antiviral agents are approved for treatment of chronic, replicative hepatitis B with liver injury, including interferon (IFN), lamivudine, adefovir, entecavir, and telbivudine.
Drug resistance, low cure rates, and side effects have been problematic.
The advantages of IFN are its limited duration of therapy, the lack of resistance, and the high response rate in terms of antigen clearance in comparison to oral agents. However, patients with advanced liver disease or decompensated cirrhosis should not be given IFN therapy because of the risk for decompensation of liver disease.
In such patients, the oral agents are used but are limited in their ability to achieve a sustained suppression of viral replication, are costly, and have a propensity for drug resistance.
Drug Treatments for Chronic Hepatitis B Infection
Drug
Dose
Efficacy
Resistance
Comments
Pegylated IFN α2a
180 mcg SC/week × 48 weeks
E Ag +: 32% lose HBeAg and suppress DNA to <20,000 IU/mL
E Ag −: 43% suppress HBV DNA to <4,000 IU/mL
No viral resistance per se
Do not use in the setting of cirrhosis (Childs B or C).
Tenofovir
300 mg daily
E Ag +: 76% suppress DNA to <69 IU/mL
E Ag −: 93% suppress DNA to <69 IU/mL
Low rate detected
Can be given as an emtricitabine coformulation; emtricitabine similar to lamivudine. (not FDA approved)
Entecavir
0.5 mg daily
E Ag +: 67% suppress DNA to <300 copies/mL; 22% lose E Ag
Not detected
Lamivudine
100 mg daily
E Ag +: 32% lose HBeAg and 44% suppress DNA to <20,000 IU/mL
High rate noted (15%/year)
Hepatitis may flare upon cessation of therapy.
Telbivudine
600 mg daily
E Ag +: 35% lose HBeAg and 56% suppress DNA to undetectable
High rate in individuals who do not suppress HCV DNA to <1,000 copies/mL by 24 weeks
Duration remains unclear.
Adefovir
10 mg daily
E Ag +: 24% lose HBeAg and 21% suppress DNA to undetectable.
E Ag −: 71% suppress DNA to <1,000 copies/mL
Not common
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