停止核苷（酸）类似物治疗的风险和益处：HBeAg 阴性慢性乙

StephenW

停止核苷（酸）类似物治疗的风险和益处：HBeAg 阴性慢性乙型肝炎患者的治疗理念
弗洛里安·范·博梅尔 1 , 托马斯·伯格 1

隶属关系联系
    1    德国莱比锡莱比锡大学医学中心内科二部肝病科。
    PMID：34558833 DOI：10.1002/hep4.1708

抽象的

系统性停用核苷（酸）类似物 (NAs) 长期治疗是提高慢性乙型肝炎 e 抗原 (HBeAg) 阴性乙型肝炎患者功能治愈率的一种策略。然而，在前瞻性试验中报告了高达 20% 的长期乙型肝炎表面抗原 (HBsAg) 丢失率。本综述提出了在慢性乙型肝炎病毒 (HBV) 患者中考虑停用 NA 时可以使用的标准。停止 NA 治疗经常导致病毒学和生化复发，这些复发经历不同的阶段：滞后期、再激活期和巩固期。在再激活阶段观察到的 HBV-DNA 耀斑通常是短暂的，很可能是特定 CD8+T 细胞诱导长期免疫控制的触发因素，因此不需要立即干预，但需要密切随访评估。停止治疗时低 HBsAg 水平预示着对 NA 停药的长期阳性反应与 HBsAg 清除的可能性较高相关。目前正在评估其他宿主和病毒生物标志物，这些生物标志物可能有助于进一步表征可能从有限 NA 治疗概念中受益最多的人群。需要及早识别再激活阶段潜在的有害生化耀斑，并可以通过重新引入 NA 治疗有效终止。肝功能失代偿对停止 NA 治疗的肝硬化患者存在风险。因此，只有在排除晚期纤维化和肝硬化并且可以保证对患者进行密切随访和由经验丰富的医生监督后，才应考虑有限 NA 方法。
结论：对于选定的患者，停用 NA 已成为控制 HBeAg 阴性 HBV 感染的有力工具。它的显着效果代表了对新治疗方法的挑战，但它也可以作为它们的增强剂。© 2021 作者。由 Wiley Periodicals LLC 代表美国肝病研究协会出版的 Hepatology Communications。

StephenW

Risks and Benefits of Discontinuation of Nucleos(t)ide Analogue Treatment: A Treatment Concept for Patients With HBeAg-Negative Chronic Hepatitis B
Florian van Bömmel  1 , Thomas Berg  1
Affiliations
Affiliation

    1
    Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.

    PMID: 34558833 DOI: 10.1002/hep4.1708

Abstract

Systematic discontinuation of long-term treatment with nucleos(t)ide analogues (NAs) is one strategy to increase functional cure rates in patients with chronic hepatitis B e antigen (HBeAg)-negative hepatitis B. Currently, available study results are heterogeneous; however, long-term hepatitis B surface antigen (HBsAg) loss rates of up to 20% have been reported in prospective trials. This review proposes criteria that can be used when considering NA discontinuation in patients with chronic hepatitis B virus (HBV). Discontinuing NA treatment frequently results in a virologic and biochemical relapse that runs through different phases: the lag phase, reactivation phase, and consolidation phase. The HBV-DNA flares observed during the reactivation phase are often transient and most likely represent a trigger for inducing a long-term immune control by specific CD8+ T cells, and therefore do not need immediate interventions but close follow-up evaluation. Low HBsAg levels at the time of treatment cessation predict a positive long-term response to NA discontinuation associated with a higher likelihood of HBsAg clearance. Other host and viral biomarkers are currently under evaluation that may prove to be helpful to further characterize the population that may benefit most from the finite NA treatment concept. Potential harmful biochemical flares during the reactivation phase need to be identified early and can be effectively terminated by reintroducing NA treatment. Hepatic decompensation represents a risk to patients with cirrhosis undergoing NA discontinuation. Therefore, the finite NA approach should only be considered after excluding advanced fibrosis and cirrhosis and if a close follow-up of the patient and supervision by an experienced physician can be guaranteed. Conclusion: For selected patients, NA discontinuation has become a powerful tool to achieve control over HBeAg-negative HBV infections. Its significant effect represents a challenge to novel treatment approaches, but it may also serve as their enhancer.

© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.

StephenW

https://aasldpubs.onlinelibrary. ... t/10.1002/hep4.1708