Ajánlás a B-, a C- és a D-vírus hepatitisek diagnosztikájára és antivirális kezelé sére

Mihály Makara, Gábor Horváth, Judit Gervain, Alajos Pár, Ferenc Szalay, László Telegdy, István Tornai, Eszter Újhelyi, Béla Hunyady

Research output: Article

10 Citations (Scopus)

Abstract

More than 1% of the Hungarian population is infected with hepatitis B, C, or D viruses. Since 2006 the diagnostics and therapy of these infections are carried out in treatment centers according to national guidelines - since 2010 according to financial protocols. The consensus-based guidelines for 2012 are published in this paper. The guidelines stress the importance of quick and detailed virologic evaluations, the applicability of transient elastography as an acceptable alternative of liver biopsy in this regard, as well as the relevance of appropriate consistent follow up schedule for viral response during therapy. The first choice of therapy in chronic hepatitis B infection is pegylated interferon for 48 weeks or continuous entecavir therapy. The later must be continued for at least 6 months after hepatitis B surface antigen (HBsAg) seroconversion. Tenofovir disoproxil fumarat is not yet reimbursed by the National Health Insurance Fund. Adefovir dipivoxil is recommended mainly in combination therapy. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection. Treatment naive chronic hepatitis C patients should initially receive pegylated interferon and ribavirin dual combination therapy. In genotype 1 infection if response is insufficient at 4 or 12 weeks one of the two new direct acting antivirals (boceprevir or telaprevir) should be added. The length of treatment is usually 48 weeks; in cases of extended early viral response shorter courses are recommended. Previous treatment failure patients with genotype 1 infection should receive a protease inhibitor backed triple combination therapy, mostly for 48 weeks. However, relapsers without cirrhosis and with extended rapid viral response, shorter telaprevir based combination therapy is sufficient. Drug-drug interactions as well as emergence of viral resistance are of particular importance. For genotype 2 or 3 HCV infections 24 weeks, for genotype 4 infections 24, 48 or 72 weeks of pegylated interferon plus ribavirin therapy is recommended in general. The guidelines published here become protocols when published as official publications of the Hungarian Health Authority.

Original languageHungarian
Pages (from-to)375-394
Number of pages20
JournalOrvosi hetilap
Volume153
Issue number10
DOIs
Publication statusPublished - márc. 1 2012

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Keywords

  • adefovir dipivoxil
  • boceprevir
  • direct acting antiviral agents
  • entecavir
  • hepatitis B virus
  • hepatitis C virus
  • hepatitis D virus
  • interferons
  • lamivudine
  • pegyleted interferons
  • ribavirin
  • telaprevir
  • tenofovir
  • viral hepatitis

ASJC Scopus subject areas

  • Medicine(all)

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