Anti-viral treatment plan for hepatitis B cirrhosis
Wang Yaojun, Department of Gastroenterology, General Hospital of Jinan Military Region
Treatment indications
Selection of drugs
Treatment target
Compensated cirrhosis
HBeAg
HBV DNA
ALT
Lamivudine 100mg qd po. no fixed course, long term use required.
Adefovir 10mg qd po. No fixed course of treatment, long-term application required.
Interferon should be used with caution and, if deemed necessary, should be started at a small dose and gradually increased to the intended therapeutic dose as tolerated by the patient
Delay and reduce the incidence of hepatic failure and HCC.
Positive
≥105 copies/ml
Normal or elevated
Negative
≥104 copies/ml
Decompensated cirrhosis
Positive
Normal or elevated
Give lamivudine on the basis of informed consent for active viral replication and inflammatory activity, but do not discontinue at will
Once resistant, replace with a nucleoside (acid) analogue that treats the resistant mutation
Interferon is contraindicated
Antiviral therapy can only delay disease progression but cannot by itself change the final outcome of end-stage cirrhosis by suppressing viral replication and improving liver function to delay or reduce the need for liver transplantation.
Antiviral treatment options for hepatitis C cirrhosis
Decompensated stage (Child-Pugh class A)
PEG-IFNα combined with ribavirin treatment regimen
Common IFNα in combination with ribavirin regimen
Treatment options for those who cannot tolerate the adverse effects of ribavirin
HCV RNA genotype 1 or (and) HCV RNA quantification ≥ 2×106 copies/ml
PEG-IFNα-2a 180μg once weekly by subcutaneous injection
Ribavirin 1000mg/d orally
IFNα 3MU~5MU, 1 intramuscular or subcutaneous injection every other day
Ribavirin 1000mg/d orally
Total 48 weeks
Common IFNα, compound IFN or PEG-IFN can be administered alone, as before.
Detect HCV RNA by 12 weeks
Decline < 2 log steps
Qualitative assay is negative or below the minimum detection limit of the quantitative method
Not negative but ≥ 2 log decreases
Discontinue
Continue treatment to 48 weeks
Continued treatment to 24 weeks with HCV RNA testing
Negative
Not negative
Continue treatment to 48 weeks
Discontinued for observation
HCV RNA gene is non-type 1 or (and) HCV RNA quantification <2×106 copies/ml
PEG-IFNα-2a 180μg once weekly by subcutaneous injection
Ribavirin 800mg/d orally
24 weeks
IFNα 3MU 3 times a week intramuscularly or subcutaneously
Ribavirin 800-1000mg/d orally
24-48 weeks
Common IFNα or PEG-IFNα can be administered alone as before.
Substitute phase
Liver transplantation