Bourlière Marc, Oules Valérie, Adhoute Xavier
Service d'hépatogastroentérologie, hôpital Saint-Joseph, 26, bd de Louvain, 13008 Marseille, France.
Rev Prat. 2018 Mar;68(3):276-282.
Hepatitis b virus infection: control or cure? Hepatitis B virus infection remains a global public health issue with changing epidemiology due to several factors including vaccination policies and migration. Approximately 254 million individuals are chronic HBsAg carrier worldwide including around 300 000 individuals in France. Host immune response plays a key role in hepatitis B pathogenesis and clinical manifestations. Hepatitis B screening should be performed in all individual with risk factors and in patients with elevated ALT. Hepatitis B vaccination should be implemented at birth or during early childhood and in individuals with risk factors. The needs for curative treatment depend mainly on the stage of the disease. Current HBV treatment are based on long term use of nucleos(t)ide analogue and rarely on the use of finite duration of pegylated interferon. The endpoints of therapy are long-term suppression of HBV replication, biochemical response and optimally durable loss of HBsAg and anti-HBs seroconversion. Current and future research aim to develop combination with antiviral therapy targeting multiple steps in the HBV lifecycle that rapidly suppress viral replication and viral antigen production and immune modulatory therapy to restore immune response to HBV in order to achieve the goal of HBV cure.
控制还是治愈？由于包括疫苗接种政策和移民在内的多种因素，乙型肝炎病毒感染仍然是一个全球公共卫生问题，其流行病学情况不断变化。全球约有2.54亿人是慢性乙肝表面抗原携带者，其中法国约有30万人。宿主免疫反应在乙型肝炎发病机制和临床表现中起关键作用。所有有危险因素的个体以及谷丙转氨酶升高的患者都应进行乙肝筛查。乙肝疫苗接种应在出生时或幼儿期以及有危险因素的个体中实施。治愈性治疗的需求主要取决于疾病阶段。目前的乙肝治疗基于长期使用核苷（酸）类似物，很少使用有限疗程的聚乙二醇化干扰素。治疗终点是长期抑制乙肝病毒复制、生化反应，以及最佳情况下持久的乙肝表面抗原消失和乙肝表面抗体血清学转换。当前和未来的研究旨在开发针对乙肝病毒生命周期多个步骤的抗病毒联合疗法，以快速抑制病毒复制和病毒抗原产生，以及免疫调节疗法来恢复对乙肝病毒的免疫反应，从而实现治愈乙肝的目标。
