Lampertico Pietro, Colombo Massimo
1st Division of Gastroenterology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy.
Liver Int. 2009 Jan;29 Suppl 1:130-2. doi: 10.1111/j.1478-3231.2008.01931.x.
Antiviral therapy is aimed to persistently suppress hepatitis B virus (HBV) to prevent liver complications and improve survival and long-term administration of nucleos(t)ide analogues represents an attractive treatment strategy. Five oral analogues are available, and all inhibit viral replication in most patients during the first year of therapy. By converse, long-term monotherapy is associated to high rates of resistance with lamivudine, and intermediate rates with Adefovir and Telbivudine. Third-generation analogues such as Entecavir and Tenofovir may efficiently inhibits viral replication in most patient for many years as they couple potency and high genetic barrier. In patients developing drug-resistance, specific rescue protocols based upon 'early add-on' have been developed to rapidly and efficiently control viral replication. In cirrhotics, long-term effective analog-based therapy prevented clinical decompensation for many years, but not liver cancer development. Long-term administration of NUCs, either as a monotherapy or as a sequential combination, inhibits HBV replication in most HBeAg-negative patients for at least 5 years, preventing clinical decompensation in cirrhotics.
抗病毒治疗旨在持续抑制乙型肝炎病毒（HBV），以预防肝脏并发症并提高生存率，长期服用核苷（酸）类似物是一种有吸引力的治疗策略。有五种口服类似物可供使用，在治疗的第一年，所有这些药物都能抑制大多数患者的病毒复制。相反，长期单一疗法与拉米夫定的高耐药率相关，与阿德福韦和替比夫定的中等耐药率相关。恩替卡韦和替诺福韦等第三代类似物由于兼具强效性和高遗传屏障，可在大多数患者中多年有效地抑制病毒复制。对于出现耐药的患者，已制定基于“早期加用”的特定挽救方案，以快速有效地控制病毒复制。在肝硬化患者中，长期有效的基于类似物的治疗可多年预防临床失代偿，但不能预防肝癌的发生。核苷类似物长期单药治疗或序贯联合治疗，可在大多数HBeAg阴性患者中抑制HBV复制至少5年，预防肝硬化患者发生临床失代偿。
