Diagnosis and therapy of hepatitis B virus infection: Czech national guidelines. The date of release: September 2017
Abstract
The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2014. The base for these guidelines were European Association for the Study of the Liver (EASL) guidelines from April 2017.
According to qualified estimates, there are 240 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection.
According to latest seroprevalent study, 0.56 % of the Czech citizens were chronically infected with HBV in 2001. Similar study was organized only in 2 regions of the Czech Republic in the year 2013 and the prevalence was only 0.064 %.
HBV infection can lead to serious life-threatening liver damage - fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The main goal of treatment is to prolong the length of life and improve its quality by preventing the progression of chronic hepatitis to cirrhosis, cirrhosis decompensation and development of HCC.
This goal can be achieved if HBV replication can be suppressed in a sustained manner. The additional goals are prevention of vertical transmission from mother to newborn, inhibition of HBV reactivation a therapy of HBV-related extrahepatic manifestations.
Generally, there are two different strategies of chronic hepatitis B therapy available - treatment with nucleoside or nucleotide inhibitors (NA) or with pegylated interferon alfa. Currently, the absolute majority of the Czech and European patients is treated with NA.
The NA that have been approved in European Union for HBV treatment include lamivudine, adefovir dipivoxil, entecavir (ETV), telbivudin (TBV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). TAF and TBV have not been commercially available in Czech Republic yet.
The main advantage of treatment with potent NA with high barrier to resistance (ETV, TDF, TAF) is its predictable high long-term antiviral efficacy leading to undetectable HBV DNA levels in vast majority of compliant patients as well as its favourable safety profile. These drugs can be used in any HBV infected patient and represent the only treatment option for patients with decompensated liver cirrhosis, liver transplants, extrahepatic HBV-related manifestations, severe acute hepatitis B or chronic HBV reactivation.