慢性乙型肝炎：“非活性攜帶者”階段的消亡

StephenW

Chronic hepatitis B: the demise of the 'inactive carrier' phase
Apostolos Koffas  1 , Manoj Kumar  2 , Upkar S Gill  3 , Ankur Jindal  2 , Patrick T F Kennedy  4 , S K Sarin  5
Affiliations
Affiliations

    1
    Department of Gastroenterology, General University Hospital of Larisa, Larisa, Greece.
    2
    Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
    3
    Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
    4
    Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. [email protected].
    5
    Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. [email protected].

    PMID: 33638770 DOI: 10.1007/s12072-021-10137-2

Abstract

Chronic hepatitis B (CHB) remains a global healthcare burden. Although the recent developments in the field have led to a reduction in incidence, the morbidity and mortality including liver cirrhosis and hepatocellular carcinoma (HCC) remain a formidable challenge. Advances in understanding the immunopathogenesis of CHB have led to a recent change in clinical categorization. EASL introduced the term hepatitis B 'e' antigen (HBeAg)-negative chronic infection, to replace the historical term 'inactive carrier' disease phase, the commonest CHB phase. Although this disease phase is associated with a favorable prognosis, it is not a truly 'inactive' disease phase with no ostensible liver disease, as inferred by the previous anachronistic terminology, and the risk of spontaneous reactivation and the potential risk of disease progression and HCC development are not negligible. Likewise, the APASL also uses the term "Incidentally Detected Asymptomatic Hepatitis B surface antigen (HBsAg)-positive Subject (IDAHS)", comprising all HBsAg-positive subjects who are incidentally detected during routine tests, without any previous or present symptoms of liver disease. This entity includes HBV infection with varied stages of liver disease. Antiviral treatment is generally reserved for patients with active inflammation and/or at risk of disease progression and HCC development. HBsAg loss is considered an optimal treatment endpoint, and may also be achievable in HBeAg-negative chronic infection and IDAHS. In light of this, and the emerging novel HBV therapies, lowering the treatment threshold and a 'Treat All' approach should now be considered. In this review, we summarize the literature and guidance on HBeAg-negative chronic infection, and we make a concerted effort to present the reasons why the one-dimensional term 'inactive carrier' should be abandoned.

Keywords: Chronic hepatitis B; Hepatitis B ‘e’ antigen-negative chronic infection; Incidentally detected asymptomatic hepatitis B ‘surface’ antigen-positive subject; ‘Inactive carrier’ disease phase.

StephenW

慢性乙型肝炎：“非活性攜帶者”階段的消亡
Apostolos Koffas 1，Manoj Kumar 2，Upkar S Gill 3，Ankur Jindal 2，Patrick T F Kennedy 4，S K Sarin 5
隸屬關係
隸屬關係

    1個
    希臘拉里薩（Larisa），拉里薩（Larisa）通用大學醫院消化科。
    2個
    印度新德里，肝臟與膽科學研究所，肝病科。
    3
    英國倫敦瑪麗女王大學巴茲利研究所巴爾茲肝臟中心，倫敦醫學院和牙科學院。
    4
    英國倫敦瑪麗女王大學巴茲利研究所巴爾茲肝臟中心，倫敦醫學院和牙科學院。 [email protected]。
    5
    印度新德里肝臟與膽科學研究所肝病科。 [email protected]。

    PMID：33638770 DOI：10.1007 / s12072-021-10137-2

抽象的

慢性乙型肝炎（CHB）仍然是全球醫療保健負擔。儘管該領域的最新發展已導致發病率降低，但包括肝硬化和肝細胞癌（HCC）的發病率和死亡率仍然是一個嚴峻的挑戰。了解CHB的免疫發病機制的進展已導致臨床分類的最新變化。 EASL引入了術語乙型肝炎“ e”抗原（HBeAg）陰性慢性感染，以取代歷史悠久的術語“非活性攜帶者”疾病階段，即最常見的CHB階段。儘管該疾病階段與良好的預後相關，但並非如先前的過時術語，自發激活的風險以及疾病進展和HCC的潛在風險所推論的那樣，它不是沒有明顯的肝病的真正“無活動”疾病階段。發展是不可忽略的。同樣，APASL也使用術語“偶然發現的無症狀乙型肝炎表面抗原（HBsAg）陽性受試者（IDAHS）”，包括在常規測試中偶然發現的所有HBsAg陽性受試者，沒有任何先前或現在的肝病症狀。該實體包括具有不同階段肝病的HBV感染。抗病毒治療通常保留給活動性炎症和/或有疾病進展和肝癌發展風險的患者。 HBsAg丟失被認為是最佳治療終點，在HBeAg陰性慢性感染和IDAHS中也可以實現。鑑於此，以及正在出現的新穎的HBV治療方法，現在應考慮降低治療閾值和“全力以赴”的方法。在這篇綜述中，我們總結了有關HBeAg陰性慢性感染的文獻和指南，並齊心協力提出了應放棄一維術語“非活性攜帶者”的原因。

關鍵字：慢性乙型肝炎；乙肝“ e”抗原陰性慢性感染；偶然發現無症狀的乙型肝炎“表面”抗原陽性受試者； “非活動攜帶者”疾病階段。