Mit 240 Millionen chronisch infizierten Betroffenen ist die Hepatitis-B-Virus (HBV)
- Infektion weltweit eine führende Ursache für die Leberzirrhose und das Leberzellkarzinom.
Zur Virusunterdrückung bei einer Infektion mit begleitender Hepatitis sind hochwirksame
antivirale Medikamente verfügbar. Neue Therapieansätze versuchen, anstelle einer Virusunterdrückung
eine Viruselimination zu erzielen.
Abstract
With approximately 240 million chronically infected people, hepatitis B virus (HBV)
infection is a leading cause of cirrhosis and hepatocellular carcinoma in the world.
Chronic HBV infection should be treated with antivirals, if either liver cirrhosis
with detectable HBV DNA or relevant viral load (HBV DNA > 2000 IU/ml) and signs of
liver damage (transaminase elevation, fibrosis, risk of liver cancer or similar) are
present. The current standard therapy is a long-term treatment with nucleoside or
nucleotide analogues such as entecavir, tenofovir disoproxil fumarate or tenofovir
alafenamide, while in selected cases interferon treatment (for 48 weeks) may be useful.
Entecavir and the new drug tenofovir alafenamide (TAF) are to be preferred over tenofovir
disoproxil fumarate in patients with concomitant renal insufficiency or osteoporosis.
Pregnant women with high viral load (> 200 000 IU/ml) should be treated with tenofovir
in the third trimester to minimize the risk of neonatal transmission (in addition
to immediate active-passive immunization). In conditions of immunosuppression (e. g.
chemotherapy, rituximab, anti-TNF), even a “healed” HBV infection may reactivate in
a life-threatening manner, requiring prophylactic antiviral therapy in addition to
testing for HBV in high-risk situations. The current therapies primarily achieve virus
suppression, but rarely the loss of HBs antigen, which is considered a functional
cure. New strategies such as discontinuation of long-term antiviral therapy with provoked
reactivation and also completely new drugs are currently in clinical trials. The most
serious form of viral hepatitis is the co-/superinfection of HBV with the delta virus
(HDV). Standard therapy for delta hepatitis is pegylated interferon-alfa, but the
approval of new drugs such as the HBV entry inhibitor Myrcludex is expected in the
near future.
Schlüsselwörter
Hepatitis B - Delta-Virus - Tenofovir - Entecavir - Reaktivierung
Key words
hepatitis B - delta virus - tenofovir - entecavir - reactivation
