Roade Luisa, Riveiro-Barciela Mar, Esteban Rafael, Buti Maria
Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, Spain.
Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, 119-129, Spain. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, Spain.
Ther Adv Infect Dis. 2021 Feb 5;8:2049936120985954. doi: 10.1177/2049936120985954. eCollection 2021 Jan-Dec.
Nucleos(t)ide analogues with high barrier to resistance are regarded as the principal therapeutic option for chronic hepatitis B (CHB). Treatment with entecavir (ETV), tenofovir disoproxil (TDF) and the later released tenofovir alafenamide (TAF) is highly effective at controlling hepatitis B virus (HBV) infection and, in the vast majority of patients, is well tolerated. No significant differences in viral suppression have been described among the different regimens, although an earlier achievement in biochemical response has been suggested first under TDF and recently under TAF. High barrier to resistance NAs rarely achieve hepatitis B surface antigen sero-clearance, and therefore should be maintained life-long in most cases. This has increased concerns about treatment-related toxicity, especially in patients under TDF with additional risk factors for kidney and bone impairment. TAF has shown a better bone and kidney safety profile than TDF, although it is not yet available worldwide due to its higher cost. Emergence of adverse events should be monitored since treatment-switch to ETV/TAF seems to be effective and safe in HBV mono-infected subjects. Finally, although an effective antiviral treatment leads to a clear improvement in clinical outcome of CHB patients; the risk of developing hepatocellular carcinoma (HCC) is not completely avoided with viral suppression. Whether tenofovir-based regimens provide any additional benefit over ETV in HCC prevention remains unclear and requires further investigation.
对耐药具有高屏障的核苷（酸）类似物被视为慢性乙型肝炎（CHB）的主要治疗选择。使用恩替卡韦（ETV）、替诺福韦酯（TDF）以及后来上市的替诺福韦艾拉酚胺（TAF）进行治疗，在控制乙型肝炎病毒（HBV）感染方面非常有效，并且在绝大多数患者中耐受性良好。尽管有人提出在TDF治疗下以及最近在TAF治疗下能更早实现生化应答，但不同治疗方案之间在病毒抑制方面尚未发现显著差异。对耐药具有高屏障的核苷（酸）类似物很少能实现乙肝表面抗原血清清除，因此在大多数情况下应终身维持治疗。这增加了人们对治疗相关毒性的担忧，尤其是在存在肾脏和骨骼损害额外风险因素的TDF治疗患者中。TAF已显示出比TDF更好的骨骼和肾脏安全性，尽管由于成本较高尚未在全球范围内广泛应用。应监测不良事件的出现，因为在HBV单一感染患者中，换用ETV/TAF治疗似乎有效且安全。最后，尽管有效的抗病毒治疗能使CHB患者的临床结局明显改善，但病毒抑制并不能完全避免肝细胞癌（HCC）的发生风险。基于替诺福韦的治疗方案在预防HCC方面是否比ETV有任何额外益处仍不清楚，需要进一步研究。
