Hepatites Virais 2017
Summary
Hepatitis B virus (HBV) infection remains a global public health
problem with changing epidemiology due to several factors
including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can
be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative
chronic infection, (IV) HBeAg-negative chronic hepatitis and (V)
HBsAg-negative phase. All patients with chronic HBV infection
are at increased risk of progression to cirrhosis and hepatocellular
carcinoma (HCC), depending on host and viral factors. The main
goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development.
The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while
HBsAg loss is an optimal endpoint. The typical indication for
treatment requires HBV DNA [2,000 IU/ml, elevated ALT and/or
at least moderate histological lesions, while all cirrhotic patients
with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in
pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide
analogue with high barrier to resistance, i.e., entecavir, tenofovir
disoproxil or tenofovir alafenamide, represents the treatment of
choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All patients
should be monitored for risk of disease progression and HCC.
Treated patients should be monitored for therapy response and
adherence. HCC remains the major concern for treated chronic
hepatitis B patients. Several subgroups of patients with HBV
