Diagnostik und Therapie der chronischen Hepatitis-B- und Hepatitis-D-Virus-Infektion

About 500,000 patients are chronically infected by the Hepatitis B virus (HBV) in Germany rendering them at risk of developing liver cirrhosis or hepatocellular carcinoma. Therefore, patients should receive therapy, if HBV viral load is > 2000 IU/ml and liver damage (e.g., repetitively elevated transaminases) is present. Also, all HBV-infected patients with already established cirrhosis require antiviral therapy if being tested positive for HBV-DNA. First line therapy options are either 48 weeks of pegylated interferon (PEG-IFN, in patients without contraindications and favorable prognostic indicators) or long-term administration of either entecavir or tenofovir that are both highly effective and have a low risk of drug resistance. Importantly, 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. All HBV-positive patients need to be tested for delta virus (HDV) infections; currently, PEG-IFN is the only effective treatment option in delta hepatitis.