我们可以在HBsAg丢失前停止核苷类似物吗？

StephenW

J Viral Hepat. 2019 Feb 25. doi: 10.1111/jvh.13091. [Epub ahead of print]
Can we stop nucleoside analogues before HBsAg loss?
Papatheodoridi M1, Papatheodoridis G1.
Author information

1
    Academic Department of Gastroenterology, Medical School of National and Kapodistrian Uinversity of Athens, Athens, Greece.

Abstract

Most of the current guidelines and the existing data suggest that long-term therapy with nucleod(t)ide analogue(s) [NA(s)] may be stopped in carefully selected chronic hepatitis B patients who remain HBsAg positive. In particular, NA(s) may be discontinued in such patients without pre-existing cirrhosis who achieved long-term on-therapy virological remission (>12 months of HBeAg seroconversion and HBV DNA undetectability for initially HBeAg-positive cases; ≥3 years of HBV DNA undetectability for HBeAg-negative cases) and are expected to remain under close follow-up after NA(s) discontinuation. The majority of patients will develop post-NA(s) virological relapses and a proportion of them will have biochemical relapses and occasionally flares, but prompt retreatment can reintroduce remission. No reliable predictor(s) of post-NA(s) relapses have been identified so far. HBsAg loss develops in a progressively increasing proportion of chronic hepatitis B patients who discontinue NA(s) with HBsAg loss rates being higher in Caucasian patients with HBeAg-negative chronic hepatitis B. Follow-up at least every 3 months for the first year seems to be appropriate for all chronic hepatitis B patients who discontinue NA(s), while HBeAg-negative patients need to be followed more closely (monthly) during the first 3 months. Predefined criteria for retreatment are quite important and the best candidates for retreatment are probably the patients with persistent (≥3 months) liver disease activity and those with severe flares. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

discontinuation; entecavir; hepatitis B; relapse; retreatment; tenofovir

PMID:
    30803099
DOI:
    10.1111/jvh.13091

StephenW

J病毒肝病。 2019年2月25日.doi：10.1111 / jvh.13091。 [印刷前的电子版]
我们可以在HBsAg丢失前停止核苷类似物吗？
Papatheodoridi M1，Papatheodoridis G1。
作者信息

1
    雅典，雅典，希腊国立和Kapodistrian Uinversity医学院消化内科学系。

抽象

大多数现行指南和现有数据表明，在精心挑选的HBsAg阳性的慢性乙型肝炎患者中，可以停止使用核苷（酸）类似物[NA（s）]的长期治疗。特别是，在没有预先存在肝硬化的患者中，NA（s）可以停用，他们实现了长期治疗中的病毒学缓解（HBeAg血清转换> 12个月，HBVA阳性病例HBV DNA检测不到;≥3年对于HBeAg阴性病例，HBV DNA检测不到），并且在NA停止后预计将继续密切随访。大多数患者将发生NA后病毒学复发，其中一部分将发生生化复发并偶尔发作，但迅速再治疗可以重新引起缓解。到目前为止，尚未发现可靠的NA后复发预测因子。慢性乙型肝炎患者HBsAg丢失的比例逐渐增加，在HBeAg阴性慢性乙型肝炎患者中停用NAs，HBsAg丢失率更高。第一年至少每3个月进行一次随访适用于所有停用NA的慢性乙型肝炎患者，而HBeAg阴性患者需要在前3个月内更密切地（每月）进行一次。重新治疗的预定标准非常重要，再治疗的最佳候选者可能是持续（≥3个月）肝病活动和严重发作的患者。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

停药;恩替卡韦;乙型肝炎;复发;再治疗;替诺福韦

结论：
    30803099
DOI：
    10.1111 / jvh.13091