[Diagnosis and treatment of chronic hepatitis B and D. Hungarian national consensus guideline].
Gábor Horváth, Béla Hunyady, Judit Gervain, Gabriella Lengyel, Mihály Makara, Alajos Pár, Ferenc Szalay, László Telegdy, István Tornai
Author Information
Gábor Horváth: Budai Hepatológiai Centrum Budapest Egry József u. 1-3. 1111 Szent János Kórház és Észak-budai Egyesített Kórházak Hepatológiai Szakambulancia Budapest.
Béla Hunyady: Somogy Megyei Kaposi Mór Oktató Kórház Belgyógyászati Osztály Kaposvár Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs.
Judit Gervain: Szent György Egyetemi Oktató Kórház I. Belgyógyászat és Molekuláris Diagnosztikai Laboratórium Székesfehérvár.
Gabriella Lengyel: Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
Mihály Makara: Egyesített Szent István és Szent László Kórház Budapest.
Alajos Pár: Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs.
Ferenc Szalay: Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest.
László Telegdy: Egyesített Szent István és Szent László Kórház Budapest.
István Tornai: Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet Debrecen.
Diagnosis and treatment of hepatitis B and D virus infections mean that the patient is able to maintain working capacity, increase quality of life, prevent cancer, and prolong life expectancy, while the society benefits from eliminating the chances of further transmission of the viruses, and decreasing the overall costs of serious complications. The guideline delineates the treatment algorithms for 2014, which is agreed on a consensus meeting of specialists involved in the treatment of the above diseases. The prevalence of hepatitis B virus infection in the Hungarian general population is 0.5-0.7%. The indications of treatment is based upon viral examinations (including viral nucleic acid determination), determinations of disease activity and stage (including biochemical, pathologic, and/or non-invasive methods), and excluding contraindications. To avoid unnecessary side effects and for cost-effective approach the guideline emphasizes 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 can be pegylated interferon for 48 weeks or continuous entecavir or tenofovir therapy. The latter two must be continued for at least 12 months after hepatitis B surface antigen seroconversion. 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.
