慢性乙型肝炎管理需求未得到满足。

StephenW

Unmet need in chronic hepatitis B management.
Liang LY1, Wong GL1.
Author information

1
    Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China.

Abstract

Despite all these exciting developments, there remain some unmet needs in the management for patients with chronic hepatitis B (CHB). As majority of CHB patients are going to use oral nucleos(t)ide analogues (NAs) for decades, Safety profile of NAs is of no doubt an important issue. The newest nucleotide analogue tenofovir alafenamide is potent in terms of viral suppression, together with favourable renal and bone safety profile. Biochemical response as reflected by alanine aminotransferase (ALT) normalization is recently found to be prognostically important. Patients who achieved ALT normalization have reduced the risk of hepatic events by 49%. Functional cure as reflected by hepatitis B surface antigen seroclearance not only implies patients may stop NA treatment, it also confers to a reduced risk of hepatocellular carcinoma and other hepatic events. Hence functional cure should be the ultimate treatment goal in CHB patients. Preemptive antiviral treatment may reduce mother-to-child transmission of hepatitis B virus, especially if birth dose of vaccination cannot be given in the first two hours after delivery. Lastly, despite the currently first-line NAs have high-genetic barrier to drug resistance mutations, there are still are many patients who were previously treated with low barrier of resistance including lamivudine, telbivudine or adefovir dipivoxil which could lead to antiviral resistance and affecting the choice of NAs.
KEYWORDS:

Cirrhosis; Hepatocellular carcinoma; Mortality; Tenofovir alafenamide; Hepatitis B

PMID:
    30754963
DOI:
    10.3350/cmh.2018.0106

StephenW

慢性乙型肝炎管理需求未得到满足。
Liang LY1，Wong GL1。
作者信息

1
    中国香港特别行政区威尔斯亲王医院医学与治疗学系。

抽象

尽管有这些令人兴奋的发展，但对慢性乙型肝炎（CHB）患者的管理仍有一些未满足的需求。由于大多数CHB患者将使用口服核苷（酸）类似物（NAs）数十年，因此NA的安全性概况无疑是一个重要问题。最新的核苷酸类似物替诺福韦艾拉酚胺在病毒抑制方面是有效的，并且具有有利的肾和骨安全性特征。最近发现丙氨酸氨基转移酶（ALT）正常化反映的生化反应在预后上是重要的。达到ALT正常化的患者将肝脏事件的风险降低了49％。乙型肝炎表面抗原血清清除反映的功能性治愈不仅意味着患者可能停止NA治疗，它还可以降低肝细胞癌和其他肝脏事件的风险。因此，功能性治愈应该是CHB患者的最终治疗目标。先发性抗病毒治疗可以减少乙型肝炎病毒的母婴传播，特别是如果在分娩后的头两个小时内不能给予疫苗接种的出生剂量。最后，尽管目前一线NAs对耐药性突变具有高遗传障碍，但仍有许多患者先前接受过低阻力治疗，包括拉米夫定，替比夫定或阿德福韦酯，这可能导致抗病毒药物耐药性并影响选择NA。
关键词：

肝硬化;肝细胞癌;死亡;替诺福韦艾拉酚胺;乙型肝炎

结论：
    30754963
DOI：
    10.3350 / cmh.2018.0106

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2018-0106.pdf