对乙型肝炎病毒长期治疗的核苷（酸）类似物治疗的当前观

StephenW

对乙型肝炎病毒长期治疗的核苷（酸）类似物治疗的当前观点
Teresa Broquetas 1 2 , 何塞 A Carrión 1 2 3
隶属关系
隶属关系

    1
    西班牙巴塞罗那德尔玛医院消化内科肝脏科。
    2
    IMIM（西班牙巴塞罗那医院医学研究所）。
    3
    西班牙巴塞罗那庞培法布拉大学医学与生命科学系。

    PMID：35936810 PMCID：PMC9346298 DOI：10.2147/HMER.S291976

抽象的

乙型肝炎病毒 (HBV) 感染仍然是一个全球公共卫生问题。本综述提出了核苷（酸）类似物（NA）的最佳当前治疗选择的更新建议。亚太肝脏研究协会、欧洲肝脏研究协会和美国肝脏疾病研究协会已经考虑了当前关于慢性乙型肝炎 (CHB) 管理的临床实践指南。慢性 HBV 感染患者肝病进展为肝硬化和肝细胞癌 (HCC) 的风险增加。治疗的主要目标是提高生存率，预防疾病进展和 HCC。诱导长期抑制 HBV 复制是当前治疗策略的主要终点，而乙型肝炎表面抗原 (HBsAg) 丢失是最佳终点。治疗的典型适应症需要 HBV 脱氧核糖核酸 (DNA) 升高、丙氨酸氨基转移酶升高和/或至少中度组织学损伤，而所有可检测到 HBV DNA 的肝硬化患者都应接受治疗。长期使用具有高耐药屏障的强效 NA，即恩替卡韦、富马酸替诺福韦酯或替诺福韦艾拉酚胺，代表了治疗的选择。然而，HBsAg 血清学清除是 NA 的传闻。应监测接受治疗的患者的治疗反应、依从性、疾病进展风险和发生 HCC 的风险。本综述旨在评估强效 NA 的发展趋势和有限治疗的新观点。

关键词：HBsAg 丢失；抗病毒治疗；功效;动力学;停止治疗。

StephenW

Current Perspectives on Nucleos(t)ide Analogue Therapy for the Long-Term Treatment of Hepatitis B Virus
Teresa Broquetas  1   2 , José A Carrión  1   2   3
Affiliations
Affiliations

    1
    Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
    2
    IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
    3
    Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.

    PMID: 35936810 PMCID: PMC9346298 DOI: 10.2147/HMER.S291976

Abstract

The hepatitis B virus (HBV) infection remains a global public health problem. This review presents updated recommendations for the optimal current treatment of choice with nucleos(t)ide analogues (NA). Current clinical practice guidelines on the management of chronic hepatitis B (CHB) by the Asian Pacific Association for the Study of the Liver, the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases have been considered. Patients with chronic HBV infection are at increased risk of liver disease progression to cirrhosis and hepatocellular carcinoma (HCC) development. The main goal of therapy is to improve survival preventing disease progression and HCC. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while hepatitis B surface antigen (HBsAg) loss is the optimal endpoint. The typical indication for treatment requires elevated HBV desoxyribonucleic acid (DNA), elevated alanine aminotransferase and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. The long-term administration of a potent NA with high barrier to resistance, ie, entecavir, tenofovir disoproxil fumarate or tenofovir alafenamide, represents the treatment of choice. However, HBsAg seroclearance is anecdotal with NA. Treated patients should be monitored for therapy response, adherence, risk of disease progression, and risk of HCC development. This review aims to assess the evolving trends on the potent NA and the new perspectives on finite therapy.

Keywords: HBsAg loss; antiviral therapy; efficacy; kinetics; treatment cessation.

StephenW

https://www.dovepress.com/getfile.php?fileID=82539