慢性乙型肝炎的治疗适应症应扩大吗？

StephenW

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Review
Clin Gastroenterol Hepatol

. 2020 May 17;S1542-3565(20)30677-7.
doi: 10.1016/j.cgh.2020.04.091. Online ahead of print.
Should Treatment Indications for Chronic Hepatitis B Be Expanded?
Wen-Juei Jeng  1 , Anna S Lok  2
Affiliations
Affiliations

    1
    Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch, Taiwan; Chang Gung University College of Medicine, Taiwan.
    2
    Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].

    PMID: 32434068 DOI: 10.1016/j.cgh.2020.04.091

Abstract

Background/aim: Antiviral therapy has greatly improved the outcomes of patients with chronic hepatitis B virus (HBV) infection and active liver disease or advanced fibrosis/cirrhosis. However, current treatment does not eradicate HBV and long-term treatment is needed in most patients to maintain clinical benefit. Thus, professional society guidelines do not recommend treatment of all patients with chronic HBV infection. This review article will examine evidence for and against expansion of treatment to patients in whom treatment is not recommended based on current guidelines.

Results: Available data support expanding treatment to immune tolerant patients and patients in the grey zones who have evidence of active/advanced liver disease based on liver biopsy or non-invasive tests and those who remain in the immune tolerant phase after age 40. Evidence supporting treatment expansion to confirmed inactive carriers and other immune tolerant patients is lacking.

Conclusion: HBV treatment indications can be more liberal when new therapies that can achieve HBsAg loss safely in a high percentage of patients after a finite course of treatment are available.

Keywords: antiviral therapy; guidelines; immune tolerant; inactive carrier.

Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

StephenW

。 2020年5月17日； S1542-3565（20）30677-7。
doi：10.1016 / j.cgh.2020.04.091。在线印刷。
慢性乙型肝炎的治疗适应症应扩大吗？
姜文瑞1，安娜·乐2
隶属关系
隶属关系

    1个
    台湾林口分院长庚纪念医院消化内科台湾长庚大学医学院。
    2
    密歇根大学安纳伯分校的胃肠病学和肝病学系。电子地址：[email protected]。

    PMID：32434068 DOI：10.1016 / j.cgh.2020.04.091

抽象

背景/目的：抗病毒治疗极大地改善了慢性乙型肝炎病毒（HBV）感染，活动性肝病或晚期纤维化/肝硬化患者的结局。但是，当前的治疗方法无法根除HBV，大多数患者需要长期治疗才能保持临床获益。因此，专业协会指南不建议对所有慢性HBV感染患者进行治疗。这篇综述文章将根据当前指南，对不建议治疗的患者扩大或支持扩大治疗的证据。

结果：现有数据支持将免疫治疗患者以及在灰色区域基于肝活检或无创性检查有活动/晚期肝病证据以及在40岁后仍处于免疫耐受阶段的患者扩大治疗范围。证据支持缺乏将治疗扩展到已证实的非活性携带者和其他免疫耐受患者的途径。

结论：在有限的疗程后，当有新的疗法可以在大部分患者中安全地实现HBsAg丢失的新疗法可用时，HBV的治疗适应症将更为宽松。

关键词：抗病毒治疗；准则；免疫耐受无效的载体。

版权所有©2020 AGA Institute。由Elsevier Inc.出版。保留所有权利。