Center of Infectious Diseases, Division of Infectious Diseases, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Adv Exp Med Biol. 2020;1179:137-186. doi: 10.1007/978-981-13-9151-4_6.
Chronic hepatitis B (CHB) remains the leading cause of liver-related morbidity and mortality across the world. If left untreated, approximately one-third of these patients will progress to severe end-stage liver diseases including liver failure, cirrhosis, and hepatocellular carcinoma (HCC). High level of serum HBV DNA is strongly associated with the development of liver failure, cirrhosis, and HCC. Therefore, antiviral therapy is crucial for the clinical management of CHB. Current antiviral drugs including nucleoside/nucleotide analogues (NAs) and interferon-α (IFN-α) can suppress HBV replication and reduce the progression of liver disease, thus improving the long-term outcomes of CHB patients. This chapter will discuss the standard and optimization antiviral therapies in treatment-naïve and treatment-experienced patients, as well as in the special populations. The up-to-date advances in the development of new anti-HBV agents will be also discussed. With the combination of the current antiviral drugs and the newly developed antiviral agents targeting the different steps of the viral life cycle or the newly developed agents modulating the host immune responses, the ultimate eradication of HBV will be achieved in the future.
慢性乙型肝炎(CHB)仍然是全球导致肝脏相关发病率和死亡率的主要原因。如果不进行治疗,这些患者中有大约三分之一将进展为严重的终末期肝病,包括肝功能衰竭、肝硬化和肝细胞癌(HCC)。血清 HBV DNA 水平高与肝功能衰竭、肝硬化和 HCC 的发生密切相关。因此,抗病毒治疗对于 CHB 的临床管理至关重要。目前的抗病毒药物包括核苷(酸)类似物(NAs)和干扰素-α(IFN-α),可以抑制 HBV 复制,减少肝病进展,从而改善 CHB 患者的长期预后。本章将讨论初治和经治患者以及特殊人群中的标准和优化抗病毒治疗。还将讨论新的抗 HBV 药物的最新进展。随着目前抗病毒药物和针对病毒生命周期不同步骤的新开发的抗病毒药物以及新开发的调节宿主免疫反应的药物的结合,HBV 的最终消除将在未来实现。