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ematrix 发表于 2022-9-27 15:20
回复 QWE11 的帖子
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APASL 建议在至少 2 年的治疗后停止治疗,如果 HBV DNA 在三个单独的样本中检测不到,相隔 6 个月[6]。 在肝硬化患者中,EASL 和 AASLD 均建议无限期长期治疗,而 HBsAg 持续阳性[7,8]。
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409197/
"在非肝硬化乙型肝炎 e 抗原 (HBeAg) 阳性患者中,持久的 HBeAg 血清转换被认为是 NUC 停药后持续反应的可靠指标[10]。因此,所有当前的指南都建议在至少 12 个月的巩固治疗(根据 APASL 最长 3 年)后,如果 HBeAg 血清学转换为抗 HBe,且 HBV DNA 检测不到且丙氨酸氨基转移酶 (ALT) 水平正常,则停止抗病毒治疗)[6-8]。
在非肝硬化 HBeAg 阴性患者中,EASL 指南建议如果患者的 HBV DNA 检测不到至少 3 年,并且如果保证治疗后随访至少 1 年,则停止 NUCs[7]。尽管 AASLD 不建议在非肝硬化 HBeAg 阴性患者中停用 NUC,但如果有令人信服的理由,并且每 3 个月仔细监测至少 1 年,他们建议停用 NUC [8]。 APASL 建议在至少 2 年的治疗后停止治疗,如果 HBV DNA 在三个单独的样本中检测不到,相隔 6 个月[6]。
在肝硬化患者中,EASL 和 AASLD 均建议无限期长期治疗,而 HBsAg 持续阳性[7,8]。另一方面,APASL 是唯一一个考虑在肝硬化患者中停止 NUC 治疗的组织,如果疾病得到补偿并在仔细的监测计划下[6]。表 11 总结了 EASL、AALSD 和 APASL 对 CHB 患者停止抗病毒治疗的当前建议。"
In non-cirrhotic hepatitis B e antigen (HBeAg)-positive patients, durable HBeAg seroconversion is considered a reliable indicator of sustained response after NUC discontinuation[10]. So, all current guidelines suggest stopping antiviral therapy if seroconversion of HBeAg to anti-HBe is achieved, along with HBV DNA undetectable and normal alanine aminotransferase (ALT) levels, after at least 12 mo of consolidation therapy (up to 3 years according to APASL)[6-8].
In non-cirrhotic HBeAg-negative patients, the EASL guidelines suggest stopping NUCs if the patient had undetectable HBV DNA for at least 3 years and if post-treatment follow-up is guaranteed for at least 1 year[7]. Although AASLD does not recommend NUC suspension in non-cirrhotic HBeAg-negative patients, they included a recommendation of NUC discontinuation if there is a compelling rationale and under careful monitoring every 3 mo for at least 1 year[8]. APASL suggests stopping therapy after at least 2 years of treatment if HBV DNA is undetectable on three separate samples, 6 mo apart[6].
In cirrhotic patients, both EASL and AASLD suggest indefinite long-term therapy while HBsAg persist positive[7,8]. On the other hand, APASL is the only organization to consider stopping NUC therapy in cirrhotic patients if the disease is compensated and under a careful monitoring plan[6]. Table Table11 summarizes current recommendations on discontinuation of antiviral therapy in CHB patients by EASL, AALSD, and APASL. |
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