Aktuelle Therapiekonzepte der chronischen Hepatitis-B-Infektion - Welche Patienten wann und wie behandeln?

Continuous progress has been achieved to improve therapy of chronic hepatitis B virus (HBV) infections. Due to the increased risk of developing liver cirrhosis or hepatocellular carcinoma, patients with an HBV viral load > 10⁴ copies/ml (2000 IU/ml) have a clear indication for antiviral therapy. In addition, all HBV-infected patients with already established advanced fibrosis or cirrhosis require antiviral therapy if being tested positive for HBV-DNA. In case of beneficial prognostic indicators and lack of contraindications, patients should be treated with pegylated interferon (PEG-IFN). Alternatively, orally administered nucleos(t)ide analogues can be used, even in decompensated liver cirrhosis. Entecavir and tenofovir are recommended as first-line therapy, if no PEG-IFN therapy is initiated. Lamivudine, adefovir and telbivudine are associated with an increased risk of selecting resistant viral mutants. In case of developing drug resistance, an antiviral compound without cross-resistance needs to be added (add-on) or replaced (switch). Moreover, anti-HBc positive patients receiving immune-suppression or chemotherapy are at increased risk of HBV reactivation; therefore, they require close monitoring and sometimes even pre-emptive antiviral therapy.