[Diagnosis and therapy of chronic hepatitis B: Czech national guidelines].

The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in April 2009. According to qualified estimates, there are 350-400 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. According to the latest seroprevalent study, 0.56 % of the Czech citizens were chronically infected with HBV in 2001. HBV infection can lead to serious life-threatening liver damage - fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The goals of treatment are to prolong the length of life and improve its quality by preventing the progression of chronic hepatitis to cirrhosis, cirrhosis decompensation and development of HCC. The goals can be achieved if HBV replication is suppressed in a sustained manner. Then, the accompanying reduction in histological activity lowers the risk of cirrhosis and HCC, particularly in non-cirrhotic patients. Currently, two different strategies for treating chronic hepatitis B are available. Treatment of finite duration is with pegylated interferon (PEG-IFN), entecavir (ETV), or tenofovir (TDV). A 48-week course of PEG-IFN is mainly recommended for HBeAg-positive patients with the best chance of anti-HBe seroconversion. Finite-duration of ETV or TDV treatment is available for HBeAg-positive patients who seroconvert to anti-HBe on treatment. However, treatment duration is unpredictable prior to the therapy as it depends on the timing of anti-HBe seroconversion and the treatment continuation following anti-HBe seroconversion (therapy should be prolonged for additional 12 months after anti-HBe seroconversion). Long-term ETV or TDV therapy is necessary for HBeAg-positive patients who do not develop anti-HBe seroconversion and for HBeAg-negative patients. This strategy is also recommended for patients with cirrhosis irrespective of the initial HBeAg status or anti-HBe seroconversion on treatment. The advantage of ETV and TDV is based on their high potency and optimal resistance profile.