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Der Internist

, Volume 59, Issue 6, pp 519–527 | Cite as

Chronische Hepatitis B und D (delta)

Gegenwärtige und zukünftige Therapien
  • N. Wortmann
  • C. Höner zu Siederdissen
  • M. CornbergEmail author
Schwerpunkt: Chronisch-entzündliche Lebererkrankungen
  • 962 Downloads

Zusammenfassung

Hintergrund

Trotz effektiver Impfungen und Therapiemöglichkeiten ist die chronische Hepatitis-B-Virus(HBV)-Infektion weltweit eine der 30 häufigsten Todesursachen. Eine Koinfektion mit dem Hepatitis-D-Virus (HDV; chronische Hepatitis delta) führt zu einem besonders raschen Progress.

Ziele

Anhand einer Analyse aktueller internationaler Leitlinien und Studien soll ein Überblick zur aktuellen und zukünftigen Therapie der chronischen Hepatitis B und delta gegeben werden.

Ergebnisse

Durch die Therapie mit Nukleosid- bzw. Nukleotidanaloga ist eine fast vollständige HBV-DNA-Suppression bei Patienten mit chronischer Hepatitis B zu erreichen, die mit einer Fibroseregression und einem geringeren Risiko für die Entwicklung eines hepatozellulären Karzinoms assoziiert ist. Eine Heilung bzw. funktionelle Heilung ist jedoch selten. Die Therapie der chronischen Hepatitis delta mit pegyliertem Interferon alfa zeigt nur geringe Ansprechraten mit hohen Rückfallquoten. In präklinischen und klinischen Studien werden derzeit verschiedene Therapieansätze untersucht, die zu einem deutlichen Abfall des Hepatitis-B-Oberflächenantigens (HBsAg) und der HDV-RNA führen.

Schlussfolgerung

Aktuelle Therapien der chronischen Hepatitis B können effektiv Folgekomplikationen reduzieren. Neue Therapieansätze versprechen zukünftig eine funktionelle Heilung der HBV-Infektion sowie effektive Behandlungsmöglichkeiten für Patienten mit chronischer Hepatitis delta.

Schlüsselwörter

Hepatitis-B-Virus Hepatitis-Delta-Virus Nukleos(t)idanaloga Pegyliertes Interferon alfa-2a Funktionelle Heilung 

Chronic hepatitis B and D (delta)

Current and future treatments

Abstract

Background

Worldwide, hepatitis B virus (HBV) infection is among the 30 leading causes of death, despite effective vaccination and therapeutic options. Chronic hepatitis delta (coinfection with hepatitis D virus) leads to a rapid disease progression.

Aims

Based on current international guidelines and studies, an overview about present and future therapeutic options for chronic hepatitis B and delta is provided.

Results

Therapy with nucleoside or nucleotide analogues leads to nearly complete HBV DNA suppression, which is associated with regression of liver fibrosis and a lower risk for the development of hepatocellular carcinoma. Therapy of chronic hepatitis delta with pegylated interferon alfa achieves only low response rates with high risk for virological relapse. Various therapeutic approaches are currently being investigated in preclinical and clinical studies and have led to a significant reduction of hepatitis B surface antigen (HBsAg) and HDV RNA.

Conclusion

Current therapies of chronic HBV infection can effectively reduce subsequent complications. New therapeutic approaches promise functional cure (HBsAg loss) of HBV infection and effective treatment options for patients with chronic hepatitis delta.

Keywords

Hepatitis B virus Hepatitis delta virus Nucleos(t)ide analogues Peginterferon alfa-2a Functional cure 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

N. Wortmann hat Fortbildungsstipendien von AbbVie erhalten. C. Höner zu Siederdissen hat Kongressstipendien von Novartis und Gilead erhalten. M. Cornberg hat Vortrags- und Beraterhonorare von Roche, Gilead Sciences und Bristol-Myers Squibb erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • N. Wortmann
    • 1
  • C. Höner zu Siederdissen
    • 1
  • M. Cornberg
    • 1
    • 2
    • 3
    Email author
  1. 1.Klinik für Gastroenterologie, Hepatologie und EndokrinologieMedizinische Hochschule HannoverHannoverDeutschland
  2. 2.Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hannover-BraunschweigHannoverDeutschland
  3. 3.Centre for Individualised Infection Medicine, c/o CRC HannoverHannoverDeutschland

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