a Department of Medicine , The University of Hong Kong , Hong Kong , Hong Kong.
b Medicine , The University of Hong Kong-Shenzhen Hospital , Shenzhen , China.
Expert Rev Clin Pharmacol. 2019 Feb;12(2):109-120. doi: 10.1080/17512433.2019.1567327. Epub 2019 Jan 21.
Chronic hepatitis B (CHB) infection causes considerable morbidity and mortality and hence should be a target for global elimination. In recent years, advances have been made in understanding the disease pathophysiology and the relationship to clinical outcome. Novel treatment targets are actively being sought in the hope of improving the treatment outlook. Areas covered: We discussed the cascade of cure of CHB with respect to the degree of persistence of viral genome and proteins. Several novel antiviral agents either targeting the virus or the host are in different clinical phases of development. Serum hepatitis B core-related antigen and HBV RNA are novel markers, which might have a role in the prediction of specific clinical outcomes such as development of hepatocellular carcinoma or virological relapse after cessation of antiviral therapy. These markers may also be used to monitor treatment response in the drug trials. Expert commentary: Global elimination of CHB is challenged by extremely low awareness of illness and poor access to care. CHB and its related complications can be reduced by birth dose vaccine, antiviral therapy, and alleviated by complication screening. Treatment options for CHB will expand in the next decade and early functional cure is not an impractical goal.
慢性乙型肝炎(CHB)感染会导致相当高的发病率和死亡率,因此应该成为全球消除的目标。近年来,人们对疾病的病理生理学及其与临床结局的关系有了更深入的了解。目前正在积极寻找新的治疗靶点,以期改善治疗前景。
我们讨论了 CHB 的治愈级联反应,涉及病毒基因组和蛋白的持续程度。几种新型抗病毒药物,无论是针对病毒还是宿主,都处于不同的临床开发阶段。血清乙型肝炎核心相关抗原和 HBV RNA 是新的标志物,它们可能在预测特定临床结局方面发挥作用,如肝细胞癌的发展或抗病毒治疗停止后的病毒学复发。这些标志物也可用于监测药物试验中的治疗反应。
极低的疾病意识和较差的治疗可及性对全球消除 CHB 构成挑战。通过出生剂量疫苗、抗病毒治疗可以减少 CHB 及其相关并发症,并通过并发症筛查加以缓解。未来十年,CHB 的治疗选择将扩大,早期功能性治愈并非不切实际的目标。