Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hepatitis B 687

■Entecavir

➣better HBV DNA suppression than lamivudine; similar HBeAg

seroconversion rate

Side Effects & Contraindications

■Interferon

➣side effects:

include flu-like syndrome, decreased WBC and platelet counts,

autoimmune disease, depression

➣contraindications:

absolute: decompensated cirrhosis, neutropenia, thrombocy-

topenia, s/p organ transplant, psychosis, uncontrolled sei-

zures, severe heart disease

relative: uncontrolled diabetes, autoimmune disease

■Lamivudine

➣side effects:

none

➣contraindications:

relative: concern re: development of resistance mutants

■Adefovir

➣side effects:

similar to placebo

➣contraindications:

concern re nephrotoxicity in post-OLT patients and decom-

pensated cirrhotics

■Entecavir

➣side effects:

similar to lamivudine

Special Situations

■Severe, decompensated liver disease

➣Oral agents preferable option

■Precore mutant infections

➣Represent subset of anti-HBe-negative patients with good

response to above agents, but relapse common; long-term ther-

apy required. If oral agent used, ones with lower initial rates of

resistance mutations (adefovir or entecavir) are favored.

■HIV co-infections

➣Represent potential for combined treatment with oral agent such

as lamivudine (higher doses) as part of multi-drug anti-HIV reg-

imen