Management of patients with hepatitis B in special populations

Table 1 Studies of nucleos/tide analogs in patients with hepatitis B related decompensated cirrhosis (adapted by Cholongitas et al[88])

Ref.	Number of patients	NA(s) used	1-yr data		Prognostic factors for the outcome
			↓ CTP score≥2, (%)	MELD score ↑
Fontana et al[17]	154	LAM	NR	NR	Serum bilirubin and creatinine levels at baseline
Schiff et al[18]	226	ADV	NR	-2	NR
Shim et al[19]	70	ETV	49	-2.2	NR
Liaw et al[20]	45/45/22	TDF/TDF + FTC/ETV	26/48/42	-2/-2/-2	NR
Chan et al[21]	114/114	LdT/LAM	32/39	-1.0/-2.0	NR
Hyun et al[22]	45/41	ETV/LAM	NR/NR	-4.9/-3.7	Baseline CTP and MELD at 3 mo
Cholongitas et al[23]	52	ETV/TDF	23.8/19.3	-0.4/-2.2	Changes in MELD score between baseline and 6 mo

NA: Nucleos/tide analogs; ADV: Adefovir; CTP: Child-Turcotte-Pugh; ETV: Entecavir; TDF: Tenofovir; FTC: Emtricitabine; HBV: Hepatitis B virus; LAM: Lamivudine; LdT: Telbivudine; MELD: Model for end stage liver disease; NR: Not reported.

Table 2 Dosage adjustment of nucleos(t)ides analogs in patients with chronic hepatitis B according to the creatinine (CrCl)[44]

CrCl (mL/min)	Lamivudine	Telbivudine	Adefovir	Entecavir1	Tenofovir
≥ 50	100 mg/d	600 mg/d	10 mg/d	0.5 mg/d	245 mg/d
30-49	50 mg/d	600 mg/2nd day	10 mg/2nd day	0.25 mg/d	245 mg/2nd day
10-29	25 mg/d	600 mg/3rd day	10 mg/3rd day	0.15 mg/d	245 mg/3rd-4th day
< 5-10 or HD2	10 mg/d	600 mg/3rd-4th day	10 mg/wk	0.5 mg/wk	245 mg/wk3

¹Recommendations only for nucleos(t)ide analog naïve patients (in lamivudine resistance the dosage is double);

²In patients undergoing HD, all agents should be given once weekly after an HD session;

³Only for patients on HD. HD: Hemodialysis.

Table 3 Management of chronic hepatitis B in special populations

Special population	Management
Before and after liver transplantation	Before: entecavir or tenofovir (± telbivudine in the presence of renal dysfunction)
	After: HBIG plus entecavir or tenofovir (consider telbivudine in the presence of renal dysfunction)
Before and after kidney transplantation	Before: entecavir or telbivudine or tenofovir (Figure 3)
	After: entecavir or telbivudine or tenofovir in HBsAg(+) recipients [plus HBIG when HBsAg(-) recipients receive graft from HBsAg(+) donor with HBV viremia] (Figure 3)
Pregnancy	lamivudine, telbivudine or tenofovir in the last trimester of pregnancy when HBV DNA > 106 IU/mL
Children	Interferon or nucleos(t)ide analogue (check age of child)
Under immunosuppressive regimen	HBsAg-positive candidates: lamivudine when baseline HBVDNA < 2000 IU/mL and short period (< 12 mo) of immunosuppression; otherwise: ETV or TDF
	HBsAg-negative/anti-HBc positive candidates: (1) if baseline HBV-DNA detectable: as HBsAg-positive candidates; (2) otherwise: lamivudine only in hematological diseases or rituximab containing regimens

HBV: Hepatitis B virus; HBIG: Hepatitis B immunoglobulin; HBsAg: Hepatitis B surface antigen; ETV: Entecavir; TDF: Tenofovir.