How does the therapy for HBV associated with PAN differ from that for PAN not associated with HBV?
In countries with a comprehensive hepatitis B vaccination program, HBV-associated PAN now accounts for <10% cases of PAN. PAN usually occurs within 4 to 6 months of acquisition of hepatitis B. HBV-associated PAN has more orchitis, hypertension, and renal infarcts. In HBV-associated PAN, the traditional treatment with corticosteroids and CTX jeopardizes the patient’s outcome by allowing the virus to persist and cause further liver damage and ongoing antigenemia. Consequently, patients who are HBsAg and HBeAg-positive are treated with a combination of:
- • Prednisone 60 mg/day for 1 week to control systemic symptoms, then tapered by 50% of dose daily until off by the end of the 2nd week.
- • Plasma exchange to remove circulating immune complexes (3 times/week for 3 weeks, 2 times/week for 2 weeks, then 1 time/week until HBeAg-negative).
- • Anti-hepatitis B viral agents to eliminate the virus. Give antiviral agent on days of plasma exchange after the procedure to maintain an adequate blood level.
Successful therapy will be accompanied by seroconversion from HBeAg to anti-HBe antibodies, which can be achieved in over 50% of patients. Patients who are negative for hepatitis C, HIV, and delta virus do best with 81% remission rate and 10% risk of relapse.
