慢性乙型肝炎的阴阳治疗-何时开始，何时停止核苷类似物治

StephenW

The Yin and the Yang of Treatment for Chronic Hepatitis B-When to Start, When to Stop Nucleos(t)ide Analogue Therapy
Samuel Hall  1 , Jessica Howell  1 , Kumar Visvanathan  2 , Alexander Thompson  1
Affiliations
Affiliations

    1
    Gastroenterology Department, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia.
    2
    Infectious Diseases Department, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia.

    PMID: 32854335 DOI: 10.3390/v12090934

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Abstract

Over 257 million individuals worldwide are chronically infected with the Hepatitis B Virus (HBV). Nucleos(t)ide analogues (NAs) are the first-line treatment option for most patients. Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are both potent, safe antiviral agents, have a high barrier to resistance, and are now off patent. They effectively suppress HBV replication to reduce the risk of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Treatment is continued long-term in most patients, as NA therapy rarely induces HBsAg loss or functional cure. Two diverging paradigms in the treatment of chronic hepatitis B have recently emerged. First, the public health focussed "treat-all" strategy, advocating for early and lifelong antiviral therapy to minimise the risk of HCC as well as the risk of HBV transmission. In LMICs, this strategy may be cost saving compared to monitoring off treatment. Second, the concept of "stopping" NA therapy in patients with HBeAg-negative disease after long-term viral suppression, a personalised treatment strategy aiming for long-term immune control and even HBsAg loss off treatment. In this manuscript, we will briefly review the current standard of care approach to the management of hepatitis B, before discussing emerging evidence to support both the "treat-all" strategy, as well as the "stop" strategy, and how they may both have a role in the management of patients with chronic hepatitis B.

Keywords: cessation; hepatitis B virus; nucleos(t)ide analogue.

StephenW

慢性乙型肝炎的阴阳治疗-何时开始，何时停止核苷类似物治疗
塞缪尔·霍尔（Samuel Hall）1，杰西卡·豪威尔（Jessica Howell）1，库马尔·维斯瓦纳森（Kumar Visvanathan）2，亚历山大·汤普森（Alexander Thompson）1
隶属关系
隶属关系

    1个
    墨尔本圣文森特医院消化内科，维多利亚州3065，菲茨罗伊，维多利亚大街41号。
    2
    墨尔本圣文森特医院传染病科，澳大利亚维多利亚州3065，菲茨罗伊，维多利亚大街41号。

    PMID：32854335 DOI：10.3390 / v12090934

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抽象

全世界有超过2.57亿人长期感染了乙型肝炎病毒（HBV）。 Nucleos（t）ide类似物（NAs）是大多数患者的一线治疗选择。恩替卡韦（ETV）和替诺福韦富马酸替诺福韦（TDF）都是有效的，安全的抗病毒药，对耐药性具有很高的阻隔性，并且现在不获专利。它们有效抑制HBV复制，以降低肝硬化，肝衰竭和肝细胞癌（HCC）的风险。由于NA治疗很少引起HBsAg丧失或功能治愈，因此大多数患者可长期持续治疗。最近出现了两种治疗慢性乙型肝炎的不同范例。首先，公共卫生着眼于“全民治疗”策略，提倡早期和终生抗病毒治疗，以最大程度地降低HCC风险和HBV传播风险。在LMIC中，与监控停药相比，该策略可以节省成本。第二，长期抑制病毒后，HBeAg阴性疾病患者“停止” NA治疗的概念，旨在长期免疫控制甚至消除HBsAg的个性化治疗策略。在本手稿中，我们将简要回顾一下当前乙型肝炎治疗的护理方法标准，然后讨论支持“全部治疗”策略和“停止”策略以及它们可能如何同时出现的新证据。在慢性乙型肝炎患者的治疗中起着重要作用。

关键词：戒烟；乙型肝炎病毒;核苷酸类似物。

StephenW

https://www.mdpi.com/1999-4915/12/9/934/pdf