处理算法的慢性乙型肝炎病毒感染在美国的管理

StephenW

Clin Gastroenterol Hepatol. 2015 Jul 15. pii: S1542-3565(15)00963-5. doi: 10.1016/j.cgh.2015.07.007. [Epub ahead of print]
A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2015 Update.Martin P1, Lau DT2, Nguyen MH3, Janssen HL4, Dieterich DT5, Peters MG6, Jacobson IM7.
Author information

• 1Division of Hepatology, University of Miami School of Medicine, Miami, Florida. Electronic address: [email protected].
• 2Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
• 3Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California.
• 4Toronto Centre for Liver Diseases, University Health Network, Toronto, Canada.
• 5Department of Medicine, The Mount Sinai Medical Center, New York, New York.
• 6Division of Gastroenterology, University of California, San Francisco, San Francisco, California.
• 7Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York.
  

AbstractChronic hepatitis B (CHB) continues to be an important public health problem worldwide, including in the United States. An algorithm for managing CHB was developed by a panel of United States hepatologists in 2004 and subsequently updated in 2006 and 2008. Since 2008, additional data on long-term safety and efficacy of licensed therapies have become available and have better defined therapeutic options for CHB. The evidence indicates that potent antiviral therapy can lead to regression of extensive fibrosis or even cirrhosis, thus potentially altering the natural history of CHB. In addition, appropriate choice of antiviral agent can minimize the risk of resistance. This updated algorithm for managing CHB is based primarily on evidence from the scientific literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy for CHB is durable suppression of serum hepatitis B virus (HBV) DNA to low or undetectable levels. CHB patients who have HBV DNA >2,000 IU/mL, elevated alanine aminotransferase (ALT), and any degree of fibrosis should receive antiviral therapy regardless of their hepatitis B e antigen (HBeAg) status. CHB patients with HBV DNA >2,000 IU/mL and elevated ALT but no evidence of fibrosis may also be considered for antiviral therapy. Approved antiviral therapies for CHB are interferon alfa-2b, peginterferon alfa-2a, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, although the preferred first-line treatment choices are peginterferon alfa-2a, entecavir, and tenofovir. In determining choice of therapy, considerations include efficacy, safety, rate of resistance, method of administration, duration, and cost.
Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

StephenW

临床Gastroenterol肝脏病。 2015年15月PII：S1542-3565（15）00963-5。 DOI：10.1016 / j.cgh.2015.07.007。 [打印EPUB的提前]
A处理算法的慢性乙型肝炎病毒感染在美国的管理：2015年更新。
马丁P1，刘DT2，阮MH3，扬森HL4，迪特里希DT5，彼得斯MG6，雅各布森IM7。
作者信息

    医药，迈阿密，佛罗里达州的迈阿密大学肝脏病1区的。电子地址：[email protected]。
    2Liver中心，胃肠科，贝斯以色列女执事医疗中心，哈佛大学医学院，马萨诸塞州波士顿。
    3Gastroenterology和肝病，斯坦福大学医学中心，斯坦福大学，加利福尼亚州。
    4Toronto中心肝病，大学健康网络，多伦多，加拿大。
    5Department医学，西奈山医疗中心，纽约，纽约。
    6Division消化内科，加州大学，旧金山，旧金山，加利福尼亚州。
    7Department医学，纽约西奈山贝斯以色列，西奈山伊坎医学院，纽约，纽约。

抽象

慢性乙型肝炎（CHB）仍然是一个重要的公共健康问题全世界，包括在美国。一种算法，用于管理CHB是由美国肝病专家组于2​​004年制定并于2006年和2008年。2008年以来随后更新，长期安全和持牌疗法疗效额外的数据已经变得可用，并更好地确定治疗选择CHB 。有证据表明，有效的抗病毒治疗可导致广泛纤维化或肝硬化甚至消退，从而有可能改变CHB的自然史。此外，抗病毒剂的适当选择可抵抗的风险降到最低。这种管理CHB更新算法主要是基于从科学文献证据。其中，数据缺乏，专案组依靠临床经验和共识专家的意见。抗病毒治疗慢性乙型肝炎的的主要目的是血清乙肝病毒（HBV）DNA持久抑制低或检测不到的水平。慢性乙型肝炎患者谁拥有HBV DNA> 2000 IU / mL时，谷丙转氨酶升高（ALT）和肝纤维化的任何程度应该接受抗病毒治疗，不论其乙肝e抗原（HBeAg）状态。慢性乙型肝炎患者与HBV DNA> 2000 IU / mL和ALT升高，但没有证据纤维化的，也可以考虑为抗病毒治疗。对于CHB批准的抗病毒治疗是干扰素α-2b，聚乙二醇干扰素α-2a的，拉米夫定，阿德福韦，恩替卡韦，替比夫定，和替诺福韦，虽然优选第一线治疗的选择是聚乙二醇干扰素α-2a的，恩替卡韦，和替诺福韦。在确定所选择的治疗，考虑包括有效性，安全性，电阻率，给药，持续时间和成本的方法。

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