M. Kukka:HBV杂志回顾 2013年1月1日，第10卷，no. 1

StephenW

HBV Journal Review
January 1, 2013, Vol 10, no 1
by Christine M. Kukka
HBV杂志回顾
2013年1月1日，第10卷，无1
由M. Kukka恭



Can Hepatitis B Patients Ever Stop Taking Antivirals? Researchers Say No
Can people infected with the hepatitis B virus (HBV) expect to clear the virus as a result of antiviral treatment? Can they expect to one day stop taking the daily antiviral pills? French researchers say no. The drug is very effective in impeding viral reproduction, but only as long as it is taken.

Researchers followed patients who took a variety of antivirals for 8.5 years to see if the drug would knock down the hepatitis B surface antigen (HBsAg) sufficiently to clear the infection. (Undetectable HBsAg and development of surface antibodies indicates a patient has cleared the infection.)

They found antivirals produced a slow but consistent reduction of HBsAg as the antiviral drugs did their work in suppressing the HBV DNA (viral load) circulating in the body. But the decline was so slow, on average it would require most patients to take antivirals for 52.2 years to totally rid their bodies of HBsAg.

They concluded that clearing HBsAg as a result of antiviral treatment, "...is unlikely to occur during a patient's lifetime, even if HBV replication is well controlled," they reported in the December 2012 issue of the Journal of Hepatology. "Thus, lifetime therapy is required in the vast majority of HBV-infected patients."
乙型肝炎患者停止服用抗病毒药物？研究人员说，没有
人与B型肝炎病毒（HBV）感染的清除病毒的抗病毒治疗的结果吗？他们期待有一天停止服用日常抗病毒药丸？法国研究人员说，没有。该药物是非常有效地阻止病毒的复制，但只要是采取。

研究人员随后采取了一系列的抗病毒药物为8.5年，如果药物打掉B型肝炎表面抗原（HBsAg），足以清除感染的患者。 （检测不到乙肝表面抗原和表面抗体的发展表明，病人已清除了感染）。

他们发现抗病毒药物产生一个缓慢的减少HBsAg的抑制HBV DNA（病毒载量），在体内循环的抗病毒药物做他们的工作，但一致的。但是这一下跌是如此缓慢，，平均它需要大多数患者采取的52.2年的抗病毒药物完全排出体内的乙肝表面抗原。

他们得出的结论是，由于抗病毒治疗，清除乙肝表面抗原“是不太可能发生在患者的生存期，即使HBV复制得到很好的控制，”他们的报告，在2012年12月发行的“中华肝脏病杂志。 “因此，终生治疗需要的HBV感染者中的绝大多数。”

StephenW

Tenofovir Found Effective in White Teens with Genotypes A and D
The antiviral tenofovir (Viread), which has already proven very effective in adults, was found equally effective in 51 HBV-infected teens in a recent clinical trial. The antiviral, which is approved by the U.S. Food and Drug Administration (FDA) for use in adults, proved equally effective in stopping replication of the virus in youths ages 12-18.

The study, published in the December issue of Hepatology, compared the effectiveness of tenofovir in primarily white, male teens treated with 300 mg of tenofovir daily over 72 weeks with 50 untreated HBV-infected teens. Nearly all participants were hepatitis B “e” antigen (HBeAg) positive and had high levels of HBV DNA.

Tenofovir dramatically suppressed HBV in the treated teens, with 89% achieving HBV DNA levels under 400 copies per milliliter and 74% achieving normal alanine aminotransferase (ALT) levels, indicating no liver damage, after 72 weeks. In contrast, none of the teens in the placebo group achieved undetectable viral load.

Among tenofovir-treated, HBeAg-positive patients, 21% lost HBeAg and one even cleared the virus—losing HBsAg and developing surface antibodies.

Also significant in the study was that tenofovir was effective in teens who had already developed drug resistance to the antiviral lamivudine (Epivir-HBV).

No side effects, such as bone density loss or neuropathy (nerve damage), were reported over the 72-week study period. Those side effects have been reported in adults treated long-term with this drug. It remains unclear if longer treatment with tenofovir in teens would cause these side effects.

While the study endorses tenofovir, and may lead to FDA approval of the drug in teens, many questions remain about whether early treatment during childhood will decrease liver cancer risk, and how long children should be treated with an antiviral. Also, because the study was based in the U.S. and Europe, the majority of those enrolled were white patients with HBV genotypes or strains A and D. Additional studies are needed to determine if the drug will be effective in Asians and those with other genotypes.


替诺福韦找到有效的白青少年基因型A和D
抗病毒药物替诺福韦（VIREAD的），这已经被证明是非常有效的成年人，在51 HBV感染的青少年在最近的临床试验中被发现同样有效。抗病毒药物，这是由美国食品和药物管理局（FDA）用于成人批准，证明同样有效阻止病毒的复制12-18岁的青少年。

这项研究发表在12月号的杂志，比较了替诺福韦主要是白人，男性青少年每天300毫克的替诺福韦治疗超过72周与50个未经处理的HBV感染的青少年。几乎所有的参与者B型肝炎的“e”抗原（HBeAg）阳性，并有较高的HBV DNA水平。

替诺福韦显着抑制HBV在治疗的青少年中，89％达到HBV DNA水平低于400拷贝每毫升，达到正常丙氨酸氨基转移酶（ALT）水平的74％，表示没有肝功能损害，后72周。相反，安慰剂组的青少年在检测不到的病毒载量。

在替诺福韦治疗的HBeAg阳性患者中，21％失去了HBeAg和一个甚至清除病毒亏损的乙肝表面抗原和表面抗体。

同样重要的研究是在青少年已经开发耐药的抗病毒药物拉米夫定（拉米HBV），替诺福韦是有效的。

无副作用，如骨质密度的损失或神经病变（神经损害），在72周的研究期间。据报道，在处理长期用此药的成年人，这些副作用。目前还不清楚是否与替诺福韦的青少年会造成更长时间的治疗，这些副作用。

虽然这项研究同意替诺福韦，并可能导致美国食品及药物管理局批准的药物在青少年中，许多问题仍然在儿童期的早期治疗是否会降低肝癌的危险，以及如何长的儿童应与抗病毒药物治疗。另外，因为研究是基于在美国和欧洲，那些参加的大多数是白人患者HBV基因型或品系A和D。进​​一步的研究是必要的，以确定是否在亚洲人和其他基因型的药物将是有效的。

StephenW

Tenofovir Effective in Patients with Advanced Fibrosis and Cirrhosis
A new study of 348 hepatitis B patients—many of whom had advanced liver inflammation (fibrosis) and scarring (cirrhosis)—found that five years of tenofovir treatment improved liver health and caused no drug resistance, according to the report in the December issue of Lancet.

The patients had liver biopsies at the start of treatment and five years later, which revealed that 87% had improvements in liver health. Fifty-one percent had reduced fibrosis. Of the 96 patients with cirrhosis at the beginning of treatment, 74% no longer had cirrhosis after five years.

"In patients with chronic HBV infection, up to 5 years of treatment with tenofovir was safe and effective," researchers noted. "Long-term suppression of HBV can lead to regression of fibrosis and cirrhosis."
替诺福韦在先进​​的肝纤维化及肝硬化的患者有效
348型肝炎，乙型肝炎患者，其中许多人拥有先进的肝脏炎症（纤维化）及疤痕（肝硬化）一项新的研究发现，替诺福韦治疗的五年提高了肝脏的健康，并造成无耐药性，根据该报告，在12月发出的柳叶刀“杂志。

开始治疗的患者有肝活检，并在5年后，这表明，87％的肝脏健康的改善。减少了百分之五十一的纤维化。在开始治疗的96例肝硬化，74％不再有肝硬化后5年。

“在慢性乙肝病毒感染的患者，长达5年的替诺福韦治疗是安全有效的，”研究人员指出。 “长期抑制乙肝病毒可导致肝纤维化和肝硬化的回归。”
Entecavir Reduces Liver Cancer by 10%, Compared to No Treatment
To find out if antiviral treatment prevents liver cancer in chronically-infected hepatitis B patients, Japanese researchers compared liver cancer rates in 316 entecavir (Baraclude)-treated patients with 316 untreated patients with similar age, gender, and disease progression.

Over five years, they found the entecavir group had a liver cancer rate of 3.7%, while the untreated group had a cancer rate of 13.7%, according to the report published in the journal Hepatology.

"Long-term entecavir treatment may reduce the incidence of (liver cancer) in HBV-infected patients," they concluded. "The treatment effect was greater in patients at higher risk of liver cancer," they added, including those who had fibrosis, cirrhosis and other signs of liver damage.
恩替卡韦降低肝癌的10％，比不治疗
如果抗病毒治疗在慢性感染B型肝炎患者预防肝癌，日本研究人员比较了肝脏的癌症发病率在316恩替卡韦（博路定）治疗的患者与316例初治的相似的年龄，性别，疾病进展。

过去五年中，他们发现恩替卡韦组有肝癌，增幅为3.7％，而未经处理的一个根据在杂志上发表的报告肝病，癌症发病率的13.7％。

“长期恩替卡韦治疗HBV感染的患者（肝癌）的发病率在降低，”他们的结论。 “患者的治疗效果肝癌的风险较高，”他们补充说，包括那些有纤维化，肝硬化等肝损伤的迹象。

StephenW

Impact of Hepatitis B on Pregnancy
• Role of HBV Genotype: Japanese researchers followed 21 pregnant women through childbirth to see what impact their HBV viral strain or genotype had on pregnancy. They reported in the journal of Internal Medicine, that women with genotype C had higher viral loads, some liver damage (evidenced by elevated ALT levels) and low platelet counts at time of delivery.

While all women in the study delivered healthy babies, four of six women with genotype C were HBeAg-positive and had high viral loads. It has been reported that people with genotype C lose HBeAg later in life, and so may still be HBeAg-positive during their child-bearing years. As a result, women with this genotype may be more likely to infect their newborns, unless preventive treatment is used, and be at risk is liver damage from prolonged years of high viral load.
B型肝炎对妊娠的影响
•HBV基因型的作用：日本研究人员随访了21通过分娩的孕妇，看看有什么影响HBV病毒株或基因型对怀孕的。他们在中华内科杂志报道，C基因型的妇女有较高的病毒载量，一些肝功能损害（ALT水平升高的证明）和低血小板计数在交货时收取。

所有参与研究的妇女产下健康的婴儿，四，六女，C基因型的HBeAg阳性和高病毒载量。据报道，C基因型的人失去HBeAg阳性以后的生活中，所以仍可能在他们的生育岁的HBeAg阳性。因此，这种基因型的妇女更有可能传染给她们的新生儿，除非使用预防性治疗，并在风险是长期的高病毒载量的肝功能损害。

• Role of Male Partner's Genotype: Another study from Japan, reported in the journal Microbiology and Immunology, found that men with HBV genotype A may be more prone to infect their pregnant partners.

This genotype may be more resilient and has been showing up more frequently among sexually active men with new hepatitis B infections. "There are concerns that horizontal transmission of HBV from these men to pregnant partners could increase," researchers noted. "These data suggest ... the possibility that the increase of genotype A may (then consequently) influence vertical (mother-to-infant) transmission of HBV."
•男性伙伴的基因型
的角色，微生物学和免疫学“杂志报道，来自日本的另一项研究发现，与HBV基因型的人，一个可能更容易传染给她们的怀孕的合作伙伴。

这个基因型可能是更有弹性，已经呈现了新的B型肝炎感染性活跃的男性更频繁地之间。 “有担心，乙肝病毒的水平传播这些人可能会增加怀孕的合作伙伴，”研究人员指出。 “这些数据表明的基因型可以然后因此影响垂直（母亲到婴儿）HBV传播的可能性增加。”

• Lamivudine treatment safe throughout pregnancy—Researchers followed 92 women who were treated with lamivudine throughout their pregnancy to see if the antiviral had any impact on the health of their newborns. According to the report published in the World Journal of Gastroenterology, the antiviral caused no abnormalities or "adverse effects" in either mothers or infants.

"Lamivudine treatment is safe for chronic HBV-infected pregnant mothers and their fetuses with a gestational age of less than 12 weeks or throughout the entire pregnancy," they reported. The antiviral also helped reduce viral load and prevent mother-to-infant infection in 97.1% of cases.
拉米夫定治疗的安全研究人员在整个孕期随后92名妇女与拉米夫定治疗在整个怀孕期间抗病毒药物，看看他们的新生儿的健康有任何影响。根据世界胃肠病学杂志发表的报告，抗病毒药物引起的异常或“不利影响”，无论是母亲或婴儿。

拉米夫定治疗慢性HBV感染的孕妇及胎儿胎龄小于12周，或在整个怀孕是安全的，“他们的报告。抗病毒药物也有助于降低病毒载量和97.1％的情况下，防止母亲对婴儿的感染

StephenW

Studies Find Hepatitis B Vaccine Protection May Wane in Late Adolescence
Two studies in Hong Kong, where universal hepatitis B immunization began in late 1983, suggest that hepatitis B vaccination protection may weaken as teens reach late adolescence.

According to a report in the journal Epidemiology and Infection, researchers monitored HBsAg status of teenage mothers treated between 1998 and 2008. All of the women should have been immunized at birth.

They found the following HBsAg-positive rates:

    Between 2 to 5% in those age 16
    Between 2 to 7% in those age 17
    And about 8% in those ages 18 and 19.

This shows that as the young women aged, their risk of hepatitis B infection increased, suggesting, "... the protective effect of the vaccine declined in late adolescence."

A second study from Hong Kong, published in the journal Infection, found that first-year university students in that city also had higher HBV infection rates as they aged. Of 2,688 students enrolled in the study, 2.9 % were HBsAg-positive.

What is significant is the infection rates increased significantly from 0.9% in students under age 18 to 5.5 % in those age 21 or older.

"Among the university students enrolled in our study, the overall prevalence of HBV infection before and after the introduction of HBV vaccination was lower than the 10 % found in the general population," researchers noted. "There was, however, a significant progressive increase with age at testing from 18 to 21 years, suggesting a previously overlooked contribution of horizontal transmission to the high prevalence of HBV infection found in our adult population."
研究发现，B型肝炎疫苗的保护可能减弱在青春期后期
，普及乙肝疫苗在1983年下半年开始，香港的两项研究表明，接种乙肝疫苗的保护可能会削弱青少年达到青春期后期。

根据杂志的流行病学和感染的一份报告中，研究人员观察了1998年至2008年间收治的十几岁的母亲HBsAg状态。所有的妇女都应该在出生时已经有免疫力。

他们发现下面的乙肝表面抗原阳性率：

    在那些年满16岁2至5％
    在那些17岁2年至7％
    而那些年龄在18岁和19 8％左右。

这表明岁的年轻女性，他们的B型肝炎感染的风险增加，这表明，“该疫苗的保护作用下降在青春期后期。”

大学一年级的学生，在这个城市的另一项研究发现，来自香港，发表在杂志上的感染，也有较高的HBV感染率随着年龄。的2,688名学生参加了这项研究中，2.9％为HBsAg阳性。

什么是重要的感染率从0.9％大幅上升至5.5％，在18岁以下的学生，在那些21岁或以上。

“在大学的学生参加在我们的研究中，HBV感染乙肝疫苗接种前和出台后的总患病率明显低于在总人口中10％的人认为，”研究人员指出。 “，然而，有一个显着的逐步增加，年龄从18岁至21岁的测试，我们的成人人口中发现HBV感染的高患病率的水平传播提出了以前被忽视的贡献。”
Silymarin Appears Beneficial in Drug Combinations
Silymarin, derived from the milk thistle plant, is an herbal supplement that is believed to help protect the liver from infection and other diseases, but researchers do not know in detail how effective this herb is and at what dose.

A recent Chinese study, published in the European Journal of Clinical Microbiology and Infectious Diseases, examined 12 studies that involved placebo, control groups that examined the effectiveness of silymarin when combined with antiviral treatments.

"Silymarin was equivalent to antiviral drug or protection liver drugs in serum transaminases, viral load and hepatic fibrosis markers," they found. "But silymarin combined with antiviral drug or antiviral drug and protection liver drugs significantly reduced the level of serum transaminases, hepatic fibrosis markers and serum TGF-β1, TNF-α, IL-6 versus antiviral drug or protection liver drugs."

They concluded that the herbal supplement, when combined with antiviral drug or antiviral drug and protection liver drugs, "may have potential therapeutic value." But they added that the data is still too limited to result in a full recommendation of the herbal supplement until additional trials and studies are conducted.
水飞蓟素出现有益的药物组合
水飞蓟素，水飞蓟厂来自，是一种草药补充，被认为有助于保护肝脏免受感染等疾病，但研究人员并不知道这种草药是如何有效详细，在什么剂量。

中国最近的研究，发表在欧洲临床微生物学和传染病杂志，审查了12项研究，涉及的安慰剂，对照组检查的有效性时，水飞蓟素与抗病毒治疗相结合。

“水飞蓟素是相当于抗病毒药物或血清转氨酶，​​病毒载量和肝纤维化标志物的保护肝脏的药物，他们发现了。” “但是，水飞蓟素具有抗病毒的药物或抗病毒药物和保护肝脏的药物相结合能显着降低血清转氨酶，​​肝纤维化标志物及血清TGF-β1，TNF-α，IL-6与抗病毒药物或保护肝脏的药物水平。”

他们的结论是，草药补充，结合抗病毒的药物或抗病毒药物和保护肝脏的药物，“可能有潜在的治疗价值。”但他们补充说，这些数据仍然太有限，导致在一个完整的草药补充剂的建议，直到进行额外的试验和研究。

U.S. Doctors Play Key Role in Screening Asian Immigrants for Hepatitis B
Asian immigrants and their offspring have high rates of chronic hepatitis B in the United States—reaching up to 10%. So what's the best way to promote screening, immunization, and treatment in this culturally diverse, at-risk population?

The family doctor is the most powerful influence in this group, according to a report published in the Journal of Immigrant Minority Health. Researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore and the Maryland Asian American Liver Cancer Education Program surveyed 877 Asian immigrants to help identify the most powerful source who could most influence screening and treatment.

Those surveyed were almost evenly split among Korean, Chinese and Vietnamese immigrants. The average age was 44, most were women, 58% were college-educated (only 34.9% claimed to speak English well) and 59.2% had lived more than 25% of their lives in the U.S. Sixty-two percent were employed, 60.1% regularly saw a physician and 67.8% had health insurance.
美国医生筛查B型肝炎的亚洲移民中发挥关键作用
亚洲移民和他们的后代有慢性B型肝炎的高利率，在美国达到10％。那么，什么是最好的方式，以促进在这个多元文化的筛选，免疫和治疗，高危人群吗？

家庭医生是本组中最强大的影响力根据在移民少数民族健康杂志公布的一份报告。从约翰霍普金斯大学彭博公共卫生学院在巴尔的摩，马里兰州亚裔美国人肝癌教育计划的研究人员调查了877亚洲移民，以帮助确定谁最能影响筛查和治疗的最强大的源。

受访者几乎各占一半在韩国，中国和越南的移民。平均年龄为44岁，大多数是妇女，58％受过大学教育的（只有34.9％的人声称自己英语说得很好），59.2％的人居住超过25％，他们的生活在美国，61％，60.1％经常看到医生和67.8％的健康保险。

Despite their education and access to health care, only 16.4% knew of a family history of HBV infection.

The most commonly reported sources for hepatitis B information among those surveyed were newspapers (especially among older respondents), physicians, friends, television, and the Internet (among younger, college-educated respondents). About 80% of respondents had heard of HBV from one of these sources.

Interestingly, among Vietnamese immigrants, community health fairs were the third most popular source of HBV information.

Across all groups, physicians were the most important sources of hepatitis B information and had the strongest impact on whether patients were screened. But unfortunately, health care providers often fail to screen Asian-American clients for hepatitis B despite clear practice guidelines on this topic that call for screening.

This study is the first of its kind and is expected to affect how experts develop a national HBV education campaign spear-headed by the U.S. Department of Health and Human Services in 2013.

尽管他们的教育和医疗保健的访问中，只有16.4％的人知道乙肝病毒感染的家族病史。

最常见的B型肝炎的受访者之间的信息来源是报纸（尤其是年龄较大的受访），医生，朋友，电视，互联网（其中包括年轻的，受过大学教育的受访者）。从这些来源之一，大约有80％的受访者听说过HBV。

有趣的是，在越南移民，社区卫生服务交易会是第三个最流行的的HBV信息来源。

在所有的群体，医生是最重要的B型肝炎信息来源和患者是否进行了筛选，有强烈的影响。但不幸的是，卫生保健提供者往往不能筛选亚洲和美国的B型肝炎的客户，尽管这个主题明确的实践指南，筛选的要求。

这项研究是首开先河，预计将影响一个国家HBV教育活动矛在2013年由美国卫生和人类服务部专家如何发展。

Hepatitis and Alcohol Abuse Contribute to Increase in Liver Deaths Among Addicts
An Australian study published in the journal Drug, Alcohol Dependence finds that death from liver disease—often resulting from viral hepatitis and alcohol abuse—is increasing among heroin-addicted people.

In their study, they found deaths from liver disease occurred at 9.8-times the rate in heroin-addicted people than among the general population and have been increasing over time. Viral hepatitis contributes to 76% of these deaths, and alcohol plays a role in 43% of them.

"Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population," they wrote. "Hepatitis B vaccination, and screening of (addicted) patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit."
肝炎和酒精滥用，有利于增加肝脏中死亡，其中吸毒者
澳大利亚的一项研究发表在杂志药物，酒精依赖发现，死亡的肝脏疾病，往往造成病毒性肝炎和酒精滥用增加之间的海洛因成瘾的人。

在他们的研究中，他们发现肝脏疾病的死亡发生在海洛因成瘾的人的9.8倍的速度比在普通人群中，并随着时间的推移不断增加。病毒性肝炎至76％的死亡和酒精发挥了作用，43％的人。

“治疗丙型肝炎病毒感染的摄取增加，以减少肝脏相关死亡率的负担，在这个人口是至关重要的，”他们写道。 “B型肝炎疫苗接种，筛选酒精使用障碍和提供简短的干预（上瘾）患者临床指征的，也可能是有益的。”
Formula Proposed to Treat and Monitor HBV Patients When They Receive Immune-Suppressing Drugs
Japanese researchers have crafted a formula when to treat people with current or resolved hepatitis B infections with antivirals if they receive immune-suppressing drugs for diseases such as osteoarthritis or rheumatoid arthritis.

Recently, doctors have discovered that inactive hepatitis B infections can rebound and become active when people are treated with immune-suppressing drugs. As a result, medical organizations worldwide have been trying to establish an algorithm for when to test these patients for hepatitis B, and at what point to treat them with antivirals in order to prevent a dangerous rebound in HBV infection.

The proposal promoted by Japan's College of Rheumatology (in a country where HBV infection was common) and published in the journal Modern Rheumatology makes the following recommendations:

    All patients starting immunosuppressive therapy should be screened for HBsAg (which indicates a current infection.)

    Those negative for HBsAg should be screened for hepatitis B core antibody (HBcAb) and hepatitis B surface antibody (HBsAb) as well (which would indicate a resolved infection.)

    Patients who are HBsAg-positive and have HBV DNA in their bloodstream should receive antivirals before starting immunosuppressive therapy.

    If patients are HBsAg- and HBV DNA-negative with resolved infections, they should have their ALTs and HBV DNA monitored monthly during treatment and for at least 12 months after finishing immunosuppressive treatment.

    If HBV DNA becomes positive, patients should immediately receive antivirals while continuing immunosuppressive therapy to avoid liver damage. "To facilitate proper management of patients with HBV infection, collaboration between rheumatologists and hepatologists is strongly encouraged," they recommended.
建议的方案进行治疗和监控乙肝患者，当他们收到的免疫抑制药物
日本的研究人员已经制作了一个公式时使用抗病毒药物治疗或解决B型肝炎感染的人，如果他们接受免疫抑制药物的疾病，如骨关节炎和类风湿关节炎。

最近，医生们发现，失活的B型肝炎感染可出现反弹，并成为积极的，当人们与免疫抑制药物治疗。因此，全球医疗机构一直在努力建立一个算法时，以测试这些病人的B型肝炎，以及在什么时候使用抗病毒药物治疗，以防止在HBV感染危险的反弹。

促进了日本的风湿病学​​院（在一个国家，HBV感染是常见的），并在现代风湿病学杂志发表的建议，提出以下建议：

    所有开始接受免疫抑制治疗的患者应进行筛选，乙肝表面抗原（这表示目前的感染。）

    这些消极的HBsAg应进行筛选，乙肝病毒核心抗体（HBcAb）和乙肝表面抗体（HBsAb阳性），以及（这表明一个解决的感染）。

    谁是病人HBsAg阳性，HBV DNA在他们的血液中免疫抑制治疗开始前应接受抗病毒药物。

    如果患者乙肝表面抗原和HBV DNA阴性解决感染，他们应该有其存在的低价竞标和HBV DNA监测治疗过程中，至少有12个月的每月完成后免疫抑制治疗。

    如果HBV DNA变为正时，患者应立即接受抗病毒药物，同时继续接受免疫抑制治疗，以避免肝损害。 “为了方便管理与HBV感染的患者，风湿病和肝病之间的合作，大力鼓励，他们建议。”
  

咬牙硬挺

感觉不太好啊，很多令人沮丧的消息

StephenW

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可能是翻译的不好?