RESUMO
Chronic infection by the hepatitis B virus (HBV) is a dynamic process that results from the interaction between HBV replication and the host's immune response. In accordance with the consensus document of the European Association for the Study of the Liver, treatment is not indicated for the immune tolerant and inactive carrier phases. However, there are situations in the 2 phases (which we could call gray areas of chronic HBV infection) in which the correct categorization of patients is not easy and in which the start of treatment can be proposed. In the immune tolerant phase, treatment could be indicated for health professionals whose responsibilities require their participation in invasive procedures. Treatment could also be indicated for pregnant women who are HBeAg-positive, ALT normal and have high HBV DNA values and for whom oral antiviral treatment is indicated during the last trimester of pregnancy to reduce the risk of vertical HBV transmission from mother to child. For patients in the inactive carrier phase who are HBeAg-negative with persistent normal ALT levels and HBV DNA ≥ 2000 IU/mL, the intensity of the hepatic lesion will determine the indication for treatment. If these patients already have established cirrhosis then treatment is indicated if the HBV DNA is detectable, regardless of the ALT level.
Assuntos
Hepatite B Crônica , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/imunologia , HumanosRESUMO
Biochemical, serological and virologic follow-up is necessary for patients with chronic untreated HBV infection while the infection persists. For patients who are inactive carriers, follow-up helps detect reactivation or loss of HBsAg. After the loss of HBsAg, follow-up is not recommended unless the patient requires immunosuppressive therapy. For patients with chronic HBeAg-negative hepatitis with normal ALT levels and a viral load between 2000 and 20,000 IU/mL, follow-up is required to assess the progression of the disease. For patients who are immune-tolerant, follow-up helps assess the spontaneous seroconversion of HBeAg.
Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/virologia , Portador Sadio , Seguimentos , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/imunologia , Humanos , Tolerância Imunológica , Carga ViralRESUMO
La mayoría de portadores crónicos del HBsAg son portadores inactivos de la hepatitis B. A pesar de que en términos generales tiene buen pronóstico a largo plazo, posee un riesgo incrementado de cirrosis hepática y hepatocarcinoma respecto a la población general. Además, es un grupo con alto riesgo de complicaciones, incluso letales, en caso de recibir medicamentos hepatotóxicos o inmunosupresores, lo cual requiere una serie de medidas diagnósticas y terapéuticas oportunas por parte del médico tratante. En este artículo presentamos una revisión de la hepatitis B inactiva, haciendo énfasis en el abordaje que debe realizarse en los escenarios clínicos que con mayor frecuencia ocurren en este grupo de pacientes.
Most chronic carriers of HBsAg are inactive carriers. Although in general have a good prognosis in the long term, have an increased risk of liver cirrhosis and hepatocellular carcinoma with respect to the general population. It is also a group at high risk of complications, even lethal, if given hepatotoxic or immunosuppressive drugs, which requires a series of diagnostic and therapeutic measures necessary for the treating physician. In this article we present a review of inactive hepatitis B, emphasizing the approach to be implemented in clinical scenarios that occur most frequently in this patient group.