Gastroenterology Department, General University Hospital of Larisa, Larisa, Greece.
IFI-Institute for Interdisciplinary Medicine/MVZ-Hamburg at the Asklepios Klinik St Georg, University of Hamburg, Hamburg, Germany.
Antiviral Res. 2020 May;177:104783. doi: 10.1016/j.antiviral.2020.104783. Epub 2020 Mar 23.
In spite of a decrease in the prevalence and incidence seen in recent years, chronic hepatitis B (CHB) still remains a major healthcare challenge, prevalent mostly in developing but also in developed regions. CHB is associated with significant morbidity and mortality, secondary to the complications of disease progression; cirrhosis and hepatocellular carcinoma (HCC). Historically, antiviral treatment has been restricted to patients with active hepatitis, established liver disease, fibrosis or cirrhosis and/or the risk of HCC development. As a result, patients with hepatitis B 'e' antigen (HBeAg) -positive chronic infection, formerly referred to as the 'immune tolerant' disease phase, have been excluded from treatment, since immune tolerant CHB had been considered 'benign' with no ostensible progressive liver disease. However, recent advances in 'decoding' the immunopathogenesis of CHB challenged the accuracy of this classical perception: it is now well-recognised that HBeAg-positive chronic infection is not characterized by immunological tolerance and that events associated with tumourigenesis are already present during this early disease phase. These findings have led to a paradigm shift: in 2017, the European Association for the Study of the Liver (EASL) recommended a change in the nomenclature and clinical categorisation of CHB and proposed lowering the threshold for antiviral treatment to include patients with HBeAg-positive chronic infection. It is anticipated that this could delay or even prevent disease progression and the development of HCC, alongside the potential to achieve functional cure (hepatitis B 'surface' antigen loss with or without development of hepatitis B 'surface' antibody). The current article reviews relevant literature and discusses the reasons for considering early treatment in CHB.
尽管近年来慢性乙型肝炎（CHB）的流行率和发病率有所下降，但它仍然是一个主要的医疗保健挑战，主要在发展中国家，但也在发达国家普遍存在。CHB 与疾病进展的并发症有关，包括肝硬化和肝细胞癌（HCC），导致发病率和死亡率显著增加。历史上，抗病毒治疗仅限于活动期肝炎、已确诊的肝病、纤维化或肝硬化以及/或 HCC 发展风险的患者。因此，乙型肝炎表面抗原（HBeAg）阳性慢性感染患者（以前称为“免疫耐受”疾病期）被排除在治疗之外，因为免疫耐受 CHB 被认为是“良性”的，没有明显的进行性肝病。然而，最近在 CHB 的免疫发病机制“解码”方面的进展挑战了这一经典观点的准确性：现在已经认识到，HBeAg 阳性慢性感染并非免疫耐受，而是在疾病早期就已经存在与肿瘤发生相关的事件。这些发现导致了观念的转变：2017 年，欧洲肝脏研究协会（EASL）建议改变 CHB 的命名和临床分类，并提出降低抗病毒治疗的阈值，将 HBeAg 阳性慢性感染患者纳入其中。预计这将延迟甚至预防疾病进展和 HCC 的发生，并有可能实现功能性治愈（乙型肝炎表面抗原丢失，无论是否产生乙型肝炎表面抗体）。本文回顾了相关文献，并讨论了考虑早期治疗 CHB 的原因。
