RESUMO
Hepatitis B virus (HBV) reactivation results from increased viral replication in inactive carriers or patients with prior infection with HBV. Reactivation may occur spontaneously or secondary to immunomodulating or immunosuppressive chemotherapy. Reactivation may manifest with no symptoms but on occasion results in acute or even severe acute hepatitis. Prevention is the best management approach, hence HBV screening using serology should be performed for all patients undergoing any immunomodulating, immunosuppressive or chemotherapeutic treatment. Antiviral prophylaxis has proven effective in inactive carriers and in some patients with former infection with HBV undergoing selected immunosuppressive therapies.
Assuntos
Hepatite B/etiologia , Hepatite B/terapia , Algoritmos , Terapia Biológica , Hepatite B/prevenção & controle , Humanos , Recidiva , Fatores de RiscoRESUMO
La reactivación del virus de la hepatitis B se debe a un aumento de la replicación del virus en pacientes portadores inactivos o con infecciones pasadas de VHB. La reactivación puede producirse espontáneamente o de manera secundaria a tratamientos de quimioterapia, inmunomoduladores o inmunosupresores. La reactivación puede manifestarse de manera asintomática pero en algunos casos puede causar hepatitis agudas e incluso hepatitis agudas graves. El mejor tratamiento es la prevención por lo que se debe realizar un cribado del VHB mediante una serología a todos los pacientes que vayan a someterse a cualquier tratamiento inmunomodulador, de quimioterapia o inmunosupresor. El tratamiento profiláctico antiviral ha demostrado ser eficaz en los pacientes portadores inactivos y en algunos pacientes con infecciones pasadas de VHB sometidos a ciertos tratamientos inmunosupresores(AU)
Assuntos
Humanos , Masculino , Feminino , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B/uso terapêutico , Antígenos da Hepatite B , Imunossupressores/uso terapêutico , Vírus da Hepatite B/isolamento & purificação , Fatores de Risco , Ciclofosfamida/uso terapêutico , Vincristina/uso terapêutico , Vírus da Hepatite B , Vírus da Hepatite B/patogenicidade , Indicadores de Morbimortalidade , Programas de Rastreamento/métodos , Antibióticos Antineoplásicos/efeitos adversos , Antineoplásicos/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Doxorrubicina/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Hepatite C Crônica/tratamento farmacológico , Interferons/farmacocinética , Ribavirina/farmacocinética , Antivirais/farmacocinética , Hepacivirus/patogenicidade , Carga Viral , Resultado do TratamentoRESUMO
Hepatitis B virus (HBV) infection is the leading cause of cirrhosis worldwide. One effective strategy to prevent recurrence or transmission of HBV infection after liver transplantation exists is prescription of Lamivudine, although it is associated with high resistance rates. Adefovir dipivoxil (AD) is a nucleotide analogue of adenosine that has achieved significant results in virologic, biochemical, and clinical parameters in lamivudine-resistant HBV-infected patients. Between 1990 and 2003 7 adult recipients of orthotopic liver transplants who experienced lamivudine-resistant HBV infection (pretransplantation or posttransplantation) were enrolled in a prospective study to administer AD for 48 weeks. At baseline they showed serum HBV DNA between 2.2 x 10(6) and 1.1 x 10(8) copies/mL. After 48 weeks of AD treatment, the median time-weighted average change in serum HBV DNA (log 10 copies/mL) was -3.19 (SD, 1.65). In 3 patients with HBV, DNA was undetectable (<400 copies/mL) at the end of the follow-up. HBe antigen seroconversion was observed in 1 patient. No significant adverse effects were recorded, except for renal functional impairment in 1 patient who had previous renal insufficiency. In our study, adefovir was an effective drug to suppression HBV replication in liver transplant recipients with lamivudine-resistant HBV. Excluding renal function abnormalities, tolerance of the drug was excellent. None of the patients developed resistance to adefovir. Therapy with AD in liver transplant recipients is effective and safe, although renal function should be monitored closely.
