慢性乙型肝炎 HBeAg 阴性患者停止核苷/核苷酸类似物治疗

StephenW

慢性乙型肝炎 HBeAg 阴性患者停止核苷/核苷酸类似物治疗
Paul J Pockros 1 2，Ashwini Mulgaonkar 1
隶属关系
隶属关系

    1个
    加利福尼亚州拉霍亚斯克里普斯诊所胃肠病学/肝病学部。
    2个
    加利福尼亚州拉霍亚斯克里普斯研究所免疫学和微生物学系。

    PMID：36398137 PMCID：PMC9666823

抽象的

大多数接受慢性乙型肝炎感染治疗的患者需要终生接受核苷/核苷酸类似物 (NA) 治疗，这些药物可抑制乙型肝炎病毒 (HBV) 复制，但无法根除病毒或实现功能性治愈。停用 NA 治疗被认为是通过激发 HBV 再激活实现功能性治愈的途径，随后在一些患者中进行免疫巩固和随后的乙型肝炎表面抗原丢失。然而，在极少数情况下，NA 治疗停药会导致严重的肝炎发作、肝功能失代偿或死亡，并且 NA 停药引起的肝功能失代偿或死亡的预测指标尚未确定。本文回顾了当前的 HBV 护理标准和最近的试验结果，这些试验阐明了 NA 治疗停止相对于功能性治愈获益的安全性。

关键词：核苷类似物；急性肝功能衰竭；慢性乙型肝炎；功能性治愈；肝脏失代偿;核苷酸类似物；复发。

版权所有 © 2022，Gastro-Hep Communications, Inc.

StephenW

Cessation of Nucleoside/Nucleotide Analogue Therapy in Chronic Hepatitis B HBeAg-Negative Patients
Paul J Pockros  1   2 , Ashwini Mulgaonkar  1
Affiliations
Affiliations

    1
    Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, California.
    2
    Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California.

    PMID: 36398137 PMCID: PMC9666823

Abstract

Most patients treated for chronic hepatitis B infection require lifelong treatment with nucleoside/nucleotide analogues (NAs), which inhibit hepatitis B virus (HBV) replication but do not eradicate the virus or achieve a functional cure. Withdrawal of NA treatment is being considered as a path to functional cure by provoking HBV reactivation, followed by immune consolidation and subsequent hepatitis B surface antigen loss in some patients. However, in rare cases, NA therapy withdrawal causes severe hepatitis flares, hepatic decompensation, or death, and predictors of hepatic decompensation or death with NA withdrawal have not been well established. This article reviews the current standard of care for HBV and the results of recent trials that clarify the safety of NA treatment cessation relative to the benefit of functional cure.

Keywords: Nucleoside analogues; acute liver failure; chronic hepatitis B; functional cure; hepatic decompensation; nucleotide analogues; relapse.

Copyright © 2022, Gastro-Hep Communications, Inc.