Hadziyannis Stephanos J, Papatheodoridis George V
Department of Medicine and Hepatology, Henry Dunant Hospital, Athens, Greece.
Semin Liver Dis. 2006 May;26(2):130-41. doi: 10.1055/s-2006-939751.
Hepatitis B e antigen (HBeAg)-negative chronic hepatitis B evolves in the natural history of chronic hepatitis B virus (HBV) infection linked with selection of nonproducing HBeAg but replication-competent HBV mutants, and may have a potentially severe and progressive course. Effective suppression of HBV replication is the main therapeutic target. Sustained off-therapy responses are rare with treatment of finite duration, except perhaps for interferon-based therapies, which induce such responses in a sizeable, yet small proportion of patients. Eventually, the majority of patients will be treated with long-term oral antiviral therapy, which improves patients' outcome but is associated with progressively increasing rates of viral resistance. The long-term resistance profile of adefovir is significantly better than that of lamivudine (LMV), whereas data for entecavir currently are limited to 2 years, with resistance developing in LMV-resistant but not in treatment-naïve patients. Combination therapy with adefovir added to LMV in LMV-resistant patients is extremely effective; cases of adefovir-resistance have not been reported to date.
乙肝e抗原（HBeAg）阴性慢性乙型肝炎是慢性乙型肝炎病毒（HBV）感染自然史中的一个阶段，与不产生HBeAg但具有复制能力的HBV突变体的选择有关，并且可能具有潜在的严重和进行性病程。有效抑制HBV复制是主要治疗目标。除了基于干扰素的疗法（可在相当一部分但比例较小的患者中诱导持续停药反应）外，有限疗程的治疗很少能产生持续停药反应。最终，大多数患者将接受长期口服抗病毒治疗，这种治疗可改善患者的预后，但与病毒耐药率的逐渐增加有关。阿德福韦的长期耐药情况明显优于拉米夫定（LMV），而恩替卡韦的数据目前仅限于2年，在拉米夫定耐药患者中会出现耐药，但在初治患者中不会。在拉米夫定耐药患者中，将阿德福韦与拉米夫定联合治疗非常有效；迄今为止尚未报告阿德福韦耐药病例。
