Diagnosis and antiviral therapy of hepatitis B and D – Hungarian Consensus Guideline : Effective from 20 September 2019 until withdrawal

Horváth, Gábor and Gerlei, Zsuzsanna and Gervain, Judit and Lengyel, Gabriella and Makara, Mihály and Pár, Alajos and Rókusz, László and Szalay, Ferenc and Tornai, István and Werling, Klára and Hunyady, Béla (2019) Diagnosis and antiviral therapy of hepatitis B and D – Hungarian Consensus Guideline : Effective from 20 September 2019 until withdrawal. GASZTROENTEROLÓGIAI ÉS HEPATOLÓGIAI SZEMLE = CENTRAL EUROPEAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 5 (4). pp. 31-43. ISSN 2415-9107

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Abstract

Diagnosis and treatment of HBV±HDV infection means for the patient to be able to maintain working capacity, to increase quality of life, to prevent cancer, and to prolong life expectancy, while society benefits from eliminating the chances of further transmission of the viruses, and decreasing the incidence and overall costs of serious complications. The guidelines outline the treatment algorithms that have been in place since 2019, developed at a consensus meeting of physicians involved in treating these diseases. The indications of treatment is based upon viral examinations (including viral nucleic acid determination) with determinations of disease activity and stage of related liver disease (by laboratory tests, pathologic, and/or non-invasive methods, i.e., elastographies or biochemical scores), and excluding contraindications. The first choices of therapy in chronic hepatitis B infection includes pegylated interferon for 48 weeks or continuous nucleotide/nucleoside analogue (NAs: entecavir or tenofovir). NAs must be continued for at least 12 months after hepatitis B surface antigen seroconversion. Some NAs are not available/not routinely used in Hungary. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection.

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