Treatment guideline methods during chemotherapy or immunosuppressive drug therapy.
AASLD
Subject to preventive treatment if HBsAg positive or Anti-HBc positive & HBV-DNA positive. If HBV-DNA is less than 2000 IU, or for shortened treatment (1 year), lamivudine or telbivudine is desirable. If HBV-DNA is more than 2000 IU and long-term treatment is necessary, entecavir or tenofovir is desirable. If HBV-DNA level remains less than 2000 IU 6 months after completion of treatment, treatment is discontinued, otherwise treatment continues (2009)
APASL
There are no guidelines (2005)
EASL
HBsAg cases are subject to treatment and HBV-DNA is to be measured in these cases although there is no defined value in which recommendation for treatment can be made. Lamivudine is most commonly used, however, it is best to be used in cases with low HBV-DNA or in conditions where resistant strains are less likely to emerge. In cases with high HBV-DNA or having a high risk of resistance, entecavir is desirable. Careful followup for HBV-DNA and liver function is necessary for HBsAG-negative, Anti-HBc-positive, and HBV-DNA-negative cases. Vaccination is recommended in HBV-seronegative cases (2009)
JAPAN
Subject to nucleoside analog treatment if HBsAg positive or if HBsAg negative and Anti-HBs or HBc positive plus HBV-DNA positive. lf HBV-DNA is negative, HBV-DNA is monitored monthly, and nucleoside analogs are administered when HBV-DNA becomes positive. Entecavir is recommended as the nucleoside analog. The timing of termination of nucleoside analog treatment will be determined in accordance to the treatment for Type B chronic hepatitis if HBsAg is positive. If Anti-HBs or Anti-HBc is positive, nucleoside analog is administered for 12 months after the completion of immunosuppressive therapy or chemotherapy. During this time, nucleoside analog treatment will be discontinued if HBV-DNA is negative and ALT is normal. Patients are closely observed for 12 months after treatment with nucleoside analogs (2009)
Abbreviations; HBsAG = hepatitis B surface antigen. Anti-HBs = antibody to HBsAg. Anti-HBc = antibody to hepatitis B core antigen. HBV-DNA = hepatitis B virus DNA.
