give a case summary of pateint with diseade hepatitiss b
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In recent years, there have been significant advances in the treatment of patients with hepatitis B who are candidates for liver transplantation. This includes the prevention and management of hepatitis B posttransplantation. However, there is no established protocol for treating these patients. Ultimately, the goal would be to have patients HBV-DNA negative pretransplantation and then to prevent HBV recurrence posttransplantation to help ensure their quality of life. Several clinical case scenarios are presented and possible treatment solutions have been suggested. The timing of a transplant is critical due to the risk of viral mutation while the patient is on a nucleoside analogue antiviral agent and waiting for an organ. One successful option might be to start therapy pretransplant and continue it posttransplant. Combination therapy appears to provide the most effective course of treatment. This should include a nucleoside analogue and patients should be covered with hepatitis B immune globulin throughout the course of therapy. Several other variations of combination therapy are discussed, but many clinical issues remain to be resolved. Guidelines for future studies designed to answer these questions are proposed.
The management of hepatitis B virus (HBV) infection is complex and depends upon multiple factors including clinical variables (eg, the presence or absence of liver inflammation and/or cirrhosis), the patient's immunologic response to infection (eg, hepatitis B e antigen status), virologic factors (eg, HBV viral load and genotype), and risk factors for disease progression (eg, age >40 years, family history of hepatocellular carcinoma, alcohol use, obesity, and diabetes).
The following topic will outline issues related to the management of hepatitis B through the use of cases studies that incorporate patient-specific clinical information and test results. Our approach to treatment is generally consistent with guidelines from the European Association for the Study of the Liver guidelines, Asian-Pacific Association for the Study of the Liver guidelines, and American Association for the Study of Liver