Tang Ceen-Ming, Yau Tung On, Yu Jun
Ceen-Ming Tang, Tung On Yau, Jun Yu, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
World J Gastroenterol. 2014 May 28;20(20):6262-78. doi: 10.3748/wjg.v20.i20.6262.
Chronic hepatitis B (CHB) virus infection is a global public health problem, affecting more than 400 million people worldwide. The clinical spectrum is wide, ranging from a subclinical inactive carrier state, to progressive chronic hepatitis, cirrhosis, decompensation, and hepatocellular carcinoma. However, complications of hepatitis B virus (HBV)-related chronic liver disease may be reduced by viral suppression. Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial. The indications for treatment are contentious, and increasing evidence suggests that HBV genotyping, as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response. The likelihood of achieving a sustained virological response is also increased by extending treatment duration, and using combination therapy. Hence the paradigm for treatment of CHB is constantly evolving. This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of HBV, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of CHB.
慢性乙型肝炎（CHB）病毒感染是一个全球性的公共卫生问题，全球有超过4亿人受到影响。其临床谱广泛，从亚临床非活动性携带者状态到进行性慢性肝炎、肝硬化、失代偿和肝细胞癌。然而，通过病毒抑制可减少乙型肝炎病毒（HBV）相关慢性肝病的并发症。目前的国际指南推荐使用聚乙二醇化干扰素、恩替卡韦或替诺福韦作为CHB感染的一线治疗，但针对个体患者的最佳治疗方法存在争议。治疗指征存在争议，越来越多的证据表明，应使用HBV基因分型以及治疗期间连续检测乙型肝炎表面抗原和HBV DNA动力学来预测抗病毒治疗反应。延长治疗时间和使用联合治疗也可增加实现持续病毒学应答的可能性。因此，CHB的治疗模式在不断演变。本文总结了不同的治疗指征，并系统回顾了各种抗病毒药物疗效的证据。它还讨论了当前指南的不足之处、在HBV耐药菌株中使用挽救治疗的情况，并强调了正在进行的新兴疗法的有前景的临床试验。这篇简要概述提供了一种最新的实用方法，以指导CHB 的临床管理。
