Figure 1. Geospatial location of treated CHB patients by health regions in the Minas Gerais state (Brazil), according to the eligibility criteria defined in the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic B Viral Hepatitis and Coinfections”, from May 2012 to September 2013, using QGIS software.

Figure 1. Geospatial location of treated CHB patients by health regions in the Minas Gerais state (Brazil), according to the eligibility criteria defined in the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic B Viral Hepatitis and Coinfections”, from May 2012 to September 2013, using QGIS software.

Figure 2. Flowchart of patients with HBC undergoing antiviral therapy, according to the eligibility criteria of the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011), Brazil. Legend: CHB, Chronic Hepatitis B; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HCV, Hepatitis C virus; HDV, Hepatitis Delta virus; and HIV, Human Immunodeficiency virus. The number of individuals differs from the total due to a lack of data.

Figure 2. Flowchart of patients with HBC undergoing antiviral therapy, according to the eligibility criteria of the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011), Brazil. Legend: CHB, Chronic Hepatitis B; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HCV, Hepatitis C virus; HDV, Hepatitis Delta virus; and HIV, Human Immunodeficiency virus. The number of individuals differs from the total due to a lack of data.

Figure 3. Distribution of treated CHB patients over 13 years, monoinfected and non-cirrhotic, eligible for antiviral therapy according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at the Central Laboratory of Public Health of Minas Gerais (Brazil). Legend: ALT, Alanine aminotransferase; DNA, deoxyribonucleic acid; ETV, entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; IFN, Interferon; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 3. Distribution of treated CHB patients over 13 years, monoinfected and non-cirrhotic, eligible for antiviral therapy according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at the Central Laboratory of Public Health of Minas Gerais (Brazil). Legend: ALT, Alanine aminotransferase; DNA, deoxyribonucleic acid; ETV, entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; IFN, Interferon; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 4. Distribution of treated CHB patients, classified as a special situation, eligible for antiviral therapy, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at the Central Laboratory of Public Health of Minas Gerais (Brazil). Legend: ALT, Alanine aminotransferase; DNA, Deoxyribonucleic acid; EFZ, Efanvirez; ETV, Entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HCV, Hepatitis C virus; HDV, Hepatitis Delta virus; HIV, Human Immunodeficiency virus; IFN, Interferon; LAM, Lamivudine; LPV, Lopinavir, RBV, Ribavirin; RTV, Ritonavir; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 4. Distribution of treated CHB patients, classified as a special situation, eligible for antiviral therapy, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at the Central Laboratory of Public Health of Minas Gerais (Brazil). Legend: ALT, Alanine aminotransferase; DNA, Deoxyribonucleic acid; EFZ, Efanvirez; ETV, Entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HCV, Hepatitis C virus; HDV, Hepatitis Delta virus; HIV, Human Immunodeficiency virus; IFN, Interferon; LAM, Lamivudine; LPV, Lopinavir, RBV, Ribavirin; RTV, Ritonavir; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 5. Flowchart of the disposition of treated CHB patients according to the therapeutic medication provided in the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011), Brazil. Legend: DNA, Deoxyribonucleic acid; EFZ, Efanvirez; ETV, Entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HIV, Human Immunodeficiency virus; LAM, Lamivudine; LPV, Lopinavir, Lt CD4+, T-lymphocytes subsets CD4+; NVP, Nevirapine; RTV, Ritonavir; TARV, antiretroviral therapy; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 5. Flowchart of the disposition of treated CHB patients according to the therapeutic medication provided in the “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011), Brazil. Legend: DNA, Deoxyribonucleic acid; EFZ, Efanvirez; ETV, Entecavir; HBV, Hepatitis B virus; HBeAg, Hepatitis B virus “e” antigen; HIV, Human Immunodeficiency virus; LAM, Lamivudine; LPV, Lopinavir, Lt CD4+, T-lymphocytes subsets CD4+; NVP, Nevirapine; RTV, Ritonavir; TARV, antiretroviral therapy; and TDF, Tenofovir. The number of individuals differs from the total due to a lack of data.

Figure 6. Distribution of rescue patients with CHB antiviral therapy applied, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil). Note: The number of individuals differs from the total due to a lack of data.

Figure 6. Distribution of rescue patients with CHB antiviral therapy applied, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil). Note: The number of individuals differs from the total due to a lack of data.

Table 1. Profile of treated CHB patients, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil).

Table 1. Profile of treated CHB patients, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Coinfections” (version 2011) and evaluated from May 2012 to September 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil).

Treatment Criteria (CPTG-CHB)Clinical-Laboratory Profile of PatientsNumber of Treated Patient’s Number of Patients Who Meet Eligibility Criteria% Conformity Eligibility Patient SelectionTherapeutic OptionsNumber of Eligible Patients Who Meet the Recommended Therapeutic Guidelines% Conformity pharmacological Selection% Overall of Non-ConformityAlgorithm 4.1HBeAg positive, non-cirrhotic18844.4IFN, TDF450.022.2Algorithm 4.2HBeAg negative, non-cirrhotic844047.6TDF, ETV3587.641.7Algorithm 4.3Cirrhotic with HBeAg positive or negative27622.2ETV, TDF583.318.5Special situationHBV-HIV Coinfection251664.0IFN + RBV318.712.0

Table 2. Distribution to rescue patients with CHB antiviral therapy applied, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Co-infections” (version 2011) and evaluated from May, 2012 to September, 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil).

Table 2. Distribution to rescue patients with CHB antiviral therapy applied, according to the algorithms “Clinical Protocol and Therapeutic Guidelines for the Treatment of Chronic Viral Hepatitis B and Co-infections” (version 2011) and evaluated from May, 2012 to September, 2013 at Central Laboratory of Public Health of Minas Gerais (Brazil).

Therapeutic in UseFirst Redemption OptionSecond Redemption Option17 LAM1 LAM + TDF **4 TDF1 ETV 1 LAM + ADF0 LAM + TDF0 TDF0 ADV + ETV0 ETV4 ADF0 LAM * + TDF **0 TDF0 ADV + ETV0 ETV10 INFα4 TDF 0 ETV 45 ETV0 ETV + TDF0 TDF0 ADV + ETV 67 TDFUntil time has no report of HBV resistant to TDF