对于选定的HBeAg阴性慢性乙型肝炎患者，停止使用核苷（酸）

StephenW

Liver Int. 2018 Feb;38 Suppl 1:90-96. doi: 10.1111/liv.13654.
Stopping long-term treatment with nucleos(t)ide analogues is a favourable option for selected patients with HBeAg-negative chronic hepatitis B.
van Bömmel F1, Berg T1.
Author information
Abstract

The immune response against the infection is impaired in patients with chronic hepatitis B, and although HBV DNA can effectively be suppressed by nucleos(t)ide analogues (NA), durable immune control is only established in a minority of patients. This especially applies in HBeAg-negative patients who usually must receive lifelong NA treatment. Calculated withdrawal of NA leads to a relapse of HBV DNA in most patients. There is evidence that this sudden exposure of viral antigens can trigger immune control in some patients which may result in HBsAg loss or a form of immune control, then sustained low HBV DNA levels and normal alanine aminotransferase (ALT). In the first prospective randomized trial investigating tenofovir treatment cessation in HBeAg-negative patients, most patients did not need retreatment after NA cessation, although all patients showed a transient relapse in HBV DNA. HBsAg loss was identified in almost 20% nearly 3 years after stopping NA. Further confirmation of these findings is needed in larger randomized trials and patients who are most likely to benefit from finite therapy must be identified to individualize NA stopping strategies. However, these results suggest that in patients without risk factors such as cirrhosis or other severe conditions, NA treatment may be stopped, as long as adequate safety rules for retreatment are followed.
KEYWORDS:

HBV; immune control; treatment cessation; withdrawal

PMID:
    29427489
DOI:
    10.1111/liv.13654

StephenW

肝脏国际。 2018年2月; 38增刊1：90-96。 doi：10.1111 / liv.13654。
对于选定的HBeAg阴性慢性乙型肝炎患者，停止使用核苷（酸）类似物进行长期治疗是一种有利的选择。
vanBömmelF1，Berg T1。
作者信息
抽象

慢性乙型肝炎患者对抗感染的免疫应答受损，虽然核苷（酸）类似物（NA）可有效抑制HBV DNA，但持久免疫控制仅在少数患者中确立。这特别适用于通常必须接受终身NA治疗的HBeAg阴性患者。 NA的计算撤销导致大多数患者的HBV DNA复发。有证据表明，这种突然暴露的病毒抗原可以引发一些可能导致HBsAg消失或一种免疫控制的患者的免疫控制，然后持续低的HBV DNA水平和正常的丙氨酸转氨酶（ALT）。在首次对HBeAg阴性患者停用替诺福韦的前瞻性随机试验中，尽管所有患者HBV DNA短暂复发，但绝大多数患者不需要再次停药。在停止NA后的近3年内，将近20％发现HBsAg消失。在更大规模的随机试验中需要进一步证实这些发现，并且必须确定最有可能从有限疗法中获益的患者，以个体化NA停药策略。然而，这些结果表明，在没有危险因素如肝硬化或其他严重病症的患者中，只要遵循适当的安全性规则，NA治疗就可以停止。
关键词：

HBV;免疫控制;治疗停止;退出

结论：
    29427489
DOI：
    10.1111 / liv.13654

StephenW

http://onlinelibrary.wiley.com/doi/10.1111/liv.13654/full