Kennedy Patrick T F, Litwin Samuel, Dolman Grace E, Bertoletti Antonio, Mason William S
Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine & Dentistry, QMUL, London E1 2AT, UK.
Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Viruses. 2017 Apr 29;9(5):96. doi: 10.3390/v9050096.
Chronic infection with hepatitis B virus (HBV) progresses through multiple phases, including immune tolerant, immune active, immune control, and, in a subset of patients who achieve immune control, reactivation. The first, the immune tolerant phase, is considered to be prolonged in duration but essentially benign in nature, lacking long-term consequences, and thus not recommended for antiviral therapy. This review challenges the notion that the immune tolerant phase is truly benign and considers the possibility that events during this phase may contribute significantly to cirrhosis, hepatocellular carcinoma (HCC), and the premature death of 25% of HBV carriers worldwide. Thus, earlier treatment than recommended by current guidelines should be considered. Low therapeutic coverage exacerbated by restrictive treatment guidelines may facilitate disease progression in many patients but also increase the risk of neonatal and horizontal transmission from untreated mothers to their children. While a prophylactic vaccine exists, there are many areas worldwide where the treatment of adults and the delivery of an effective vaccination course to newborns present difficult challenges.
慢性乙型肝炎病毒（HBV）感染会经历多个阶段，包括免疫耐受期、免疫活跃期、免疫控制期，并且在一部分实现免疫控制的患者中会出现再激活。第一个阶段，即免疫耐受期，被认为持续时间较长，但本质上是良性的，没有长期后果，因此不建议进行抗病毒治疗。本综述对免疫耐受期真正良性这一观点提出质疑，并考虑了该阶段发生的事件可能对肝硬化、肝细胞癌（HCC）以及全球25%的HBV携带者过早死亡有重大影响的可能性。因此，应考虑比现行指南推荐的更早进行治疗。限制性治疗指南加剧了治疗覆盖率低的问题，这可能会促使许多患者病情进展，但也增加了新生儿以及未治疗母亲向其子女进行水平传播的风险。虽然存在预防性疫苗，但在世界许多地区，成人治疗以及为新生儿提供有效的疫苗接种疗程都面临着严峻挑战。
