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genotip B lebih rendah dibandingkan dengan genotip C. Perbedaan respons terapi antara genotip B dan C: Interferon: respons pada genotip B lebih baik daripadagenotip C Lamivudin: respons sebanding anatara genotip B dan CKekambuhan pada genotip B lebih rendah dibandingkan CKekebalan lamivudin sebanding antara genotip B dan C Adefovir: sebanding antara genotip B dan CPerbedaan respons terapi antara genotip A dan D: Interferon: respons genotip A lebih baik dibandingkandengan genotip D Lamivudin: respons genotip D lebih baik dibandingkangenotip A.* .Kekebalan terhadap lamivudin: genotip A lebih seringdibandingkan genotip D Adefovir: sebanding antara genotip A dan DAnalog nukleosid dan transplantasi hati. Pada pasien infeksi VHB yang perlu dilakukan transplantasi hati sangat sulit untuk melakukan eradikasi( VHB sebelum transplantasi. Bila pasien tersebut dilakukan transplantasi maka angka kekambuhan infeksi VHB pasca transplantasi sangat tinggi karena pasca transplantasi semua pasien mendapat terapi imunosupresif yang kuat. Karena itu, dulu para ahli sempat meragukan manfaat transplantasi hati pasien hepatitis B. Dengan adanya terapi anti virus spesifik yang dapat menghambat progresi penyakit hati setelah transplantasi, maka kini transplantasi tetap diberikan kepada pasien infeksi VHB. Penelitian menunjukkan bahwa dengan menggunakan gabungan Hepatitis B immune globulin (HBG) dengan lamivudin kekambuhan infeksi VHB pasca transplantasi dapat ditekan sampai kurang dari 10%. Di samping itu, lamivudin ternyata bisa memperpanjang angka harapan hidup pasca transplantasi.REFERENSIBrunt EM. Grading and staging: the histopathological lesions of chronic hepatitis: the knodell histology activity index and beyond. Hepatology. 2000;31:241.Chien RN, Liaw YF, Chen TC, Yen CT and Sheen IS. Efficacy of thymosin alpha I in patient with chronic hepatitis B: a randomized, controlled trial. Hepatology. 1998; 27:1383.Chu CJ, Hussain M and Lok AS. Hepatitis B virus genotype B is associated with earlier HBeAg seconversion compared with hepatitis B virus genotype C, Gastroenterology. 2002;122:1756.Cohard M, Poynard T, Mathurin P and Zarski JP. Prednisone-inter-feron combination in the treatment of chronic hepatitis B: direct and indirect meta-analysis. Hepatology. 1994;20:1390,Colquhoun SD, Belle SH, Samuel D, Pruett TL and Teperman LW. Traniplantion in the hepatitis B patient and current therapiei to prevent recurrence. Semin Liver Oil, 2000;20:(SuppU):7-12,Cenj8v8m HS, Lek AS,' Management ef ehreaie hepatitis B, J Hepatol. 2003;38:59O-S10i,Cookiley WOE, Piratviiuth T, Wang YJ, et all Peginterferon alfa-

2a (40kDa): an advance in the treatment of hepatitis 3 e md-gen-positive chronic hepatitis B. J viral Hepatitis. 2003; 10*^91-' 305. Ferrari C, et at. Immunopathogenesis of hepatitis B. J Hepaid-v.-2003;39:36-42. Cerlich WH, Thomssen R. Quantitative assays for hepatitis B vrwDNA: standardization and quality control. Viral Hep2:;r.s Xr*1995;l:53-7. Gish RG, Keefe EB. Recent development in the treatment z: :v:~_HBV infection. Exp Opin Invest Drug. 1995; 4(2): 9: Guan R, Yu HK. Hepatitis B current strategies for prevent: :z etcmanagement. Med prog. 1997;?l-8. Guidotti LG, et al. Viral clearance without destructioncell during active HBV infection. Science. 1999;28^.:: Gut Freund KS, William M, Georg R, Bain VG, Ma MM, ':'EM. Genotypic succession of mutation of the hepatitis B vsmpolymerase associated with lamivudine resistance. J HepmaL2000; 4(suppl):41-50. Hoofnagle JH, Di Bisceglie AM. The treatment of chromic rcm.hepatitis. N Engl J Med. 1997;336:347-56. Hoofcagle JH, Lau D. New therapies for chronic hepatitis EHepatitis. 1997;4 (suppl.l):41-50. Honkoop P, de Man RA, Niesters HG. Zondervan PE a-.:SW. Acute exacerbation of chronic hepatitis B virus -rrr;awafter withdrawal of lamivudine therapy. Hepatciap2000;32:635. Hu K. A practical approach to management of chronic heperaInt J M. 2005;4:30-50. Ishak KG. Pathologic features of chronic hepatitis: a review update Am J Chin Pathol. 2000;113-40. Janssen HLA, Van Zonneveld M, Senturk Hepatitis, et ai Pegifcinterferon alfa-2b or in combination with lamivudine for Ipositive chronic hepatitis B: a randomized trial.2005;365:123-9. Jonas MM, Kelly DA, Mizerski J, Badia IB, Areias JA, SJnna 1Little NR, Greensmith MJ, Gardner SD, Bell MS, Sott EKelley DA. International Pediatric Lamivudine \z .Group. Clinical trial of lamivudine in children with ^ranchepatitis B. N Engl J Med. 2002:346:1706. Kapoo D, Guptan RC, Wakil SM, Kazim SN, Kaul R, Area^i. SSL al. Beneficial effect of lamivudine in hepatitis B virjs-^saBBdecompensated cirrhosis. J Hpatol. 2O0O;33:308-.: Kao J.H., Wu N.H., Chen P.J., Lai M.Y. and Chen D.S. Hepaaagenotypes and the response to interferon therapy.2000;33:998. Knodell RG, Ishak KG, Waggoner J. Formulation and appjnumerical scoring system for assessing histologies. =.::. asymptomatic chronic active hepatitis. Hepatolog) Lai CL, Ratziu, Yue MF, Poynard T. Viral hepatitis =2003;362:2089-94. Lai CL, Yuen MF. Perspective on the treatmec: :: ::.hepatitis B. In: Zuckerman, editor. Hepatitis B in At i: *i^hRegion. Volume 1. Londoi): Royal College of Ph>s.: i:p. 155-667..' .Lee WM. Hepatitis B virus infection. N Engl J Med. 199" Leung N. Therapeutic guidelines on management of :i*rathepatitis B in Asia; 2001. Available :-. -vww.mtdtclna.org.Hk/fmshk/apr2Q01/sf20010402 htm. Liaw YF, Leung NW, Chang TT, Ouan R, Tai DI, Ng KY Chat Deal 1, Rsfflan L, Idmundisn S, and Lai CL. EShm iextended lamivudlne therapy In Alias patient *;shepatitis I, Alia Hepatitli Lamivudine StudyGastroenterology. 2000; 119:172.