Chin Ruth, Locarnini Stephen
Victorian Infectious Diseases and Centre for Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Victoria 3051, Australia.
Rev Med Virol. 2003 Jul-Aug;13(4):255-72. doi: 10.1002/rmv.393.
The clinical management of chronic hepatitis B infection has entered a new era with the introduction and widespread use of oral nucleoside analogues such as lamivudine and nucleotides such as adefovir dipivoxil. From this, new challenges have now emerged in terms of preventing antiviral drug resistance, promoting viral clearance and improving long-term survival. For example, the natural history of nucleoside or nucleotide analogue-associated hepatitis B virus resistant mutants has yet to be determined. Furthermore, the increasing prevalence of HBeAg negative disease with its reduced response to current therapies represents an ongoing challenge to attempts to improve standard of care. There is increasing recognition of the pivotal role that viral load and genotype, and their complex interactions with the host immune response, play in determining the outcome of these treatment interventions. The purpose of this paper is to highlight several key factors that should be considered in the context of future clinical research and management of chronic hepatitis B.
随着拉米夫定等口服核苷类似物以及阿德福韦酯等核苷酸类药物的引入和广泛应用，慢性乙型肝炎感染的临床管理进入了一个新时代。由此，在预防抗病毒药物耐药性、促进病毒清除以及提高长期生存率方面出现了新的挑战。例如，核苷或核苷酸类似物相关的乙型肝炎病毒耐药突变体的自然史尚未确定。此外，HBeAg阴性疾病的患病率不断上升，且对当前治疗的反应降低，这对提高护理标准的尝试构成了持续挑战。人们越来越认识到病毒载量和基因型及其与宿主免疫反应的复杂相互作用在决定这些治疗干预结果中所起的关键作用。本文的目的是强调在未来慢性乙型肝炎的临床研究和管理中应考虑的几个关键因素。
