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home - Liver - Hepatitis B - Hepatitis B Drug Treatment Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Also...

Knowledge


Identifies patients with acute hepatitis B and can a rtain the
severity of their illness

Defines the different phases of chronic hepatitis B infection with a
clear understanding of serological results

Appreciates risks of transmission to close contacts
Has awareness of indications for therapy in both HBeAg positive and
negative hepatitis and the potential influence of genotype on choice of
therapy

Identifies patients where prophylaxis is required to prevent
reactivation and vertical transmission

Can determine an appropriate surveillance programme for those
patients with varices and/or hepatocellular carcinoma

Identifies patients who are appropriate candidates for liver transplant


Skills
Demonstrates ability to take a relevant history perform examination
and organise appropriate investigations

Able to advise risks of viral transmission
Interprets results of blood tests for hepatitis B antigen and antibody
Appreciates when liver biopsy is appropriate
Be able to select the most appropriate treatment and how to monitor
patient response

Able to select appropriate imaging techniques for evaluation of
abnormal results
Behaviours
Appreciates the cultural differences in the ethnic populations infected
and the influence this may have on screening


Provides advice and education to families and shows appreciation of
the potential difficulties that may arise

Understands the importance of cooperation with virologists and staff
in other clinical laboratories

Hepatitis B Drug Treatment

Written by Dr Sebastian Zeki Hepatitis B Drug Treatments Entecavir Advantages 1) Potent antiviral 2) Low resistance (1% with up to 4 years of treat-ment)Role:For primary HBV txFor decompen-sated cirrhosis as potent antiviral activity and low rate of drug resistance Telbivudine Advantages: Slightly better than lamivu-dine and adefovirDiasadvan-tages:It selects for the same resistant mutants as lamivudine and entecavir and is more expen-siveRole:As primary therapy is limited Tenofovir Advantages:1) More potent than adefovir 2)Suppresses wild-type and lamivudine-resistant HBVRole1) As first line or for lamivudine resistance2) For non-responders to adefovir Rare Negligible Negligible Nephrotoxic Negligible Many Side effects <1% at 2 years BUT: 50 % @ 5yrs if lamivudine-refractory 25% at 2 years 30% at 5 years 70% @5 years Nil Resistance: Duration of treatment: 1 year for e+ve and -ve (except IFN in e+ve disease- 4-12 mnths) Adefovir Advantages: 1) Activity against lamivudine-resistant HBV Disadvantages:1) Slow virus suppression 2) 25 % get no viral suppressionRole:1)Part of combo for lamivudine resistanceTenofovir has taken over its role Lamivudine Advantages:1)Cheap2) Years of experi-ence3) Safe in preg-nancyDisadvantages:High resistance rateNeeds renal dose reductionViral suppression worse than others except adefovirRole:Used less and lessUseful in HIV (as part of HIV regi-men) Interferon Advantages: 1)Finite duration of treatment, 2)No resistance3)Durable responseDisadvantages:1) Severe side effects2) C/I in decompen-sated diseaseRole: Compensated/ young/ short term/ genotype A

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