Vallet-Pichard Anaïs, Pol Stanislas
Département d'Hépatologie, Université Paris Centre, Hôpital Cochin, APHP, INSERM U1223, Institut Pasteur, Paris, France.
Aliment Pharmacol Ther. 2021 Jun;53(11):1166-1182. doi: 10.1111/apt.16356. Epub 2021 Apr 28.
Chronic hepatitis B virus (HBV) infection results in a high risk of cirrhosis and its complications: cirrhosis decompensation, hepatocellular carcinoma (HCC, the fourth most common cause of cancer-related mortality worldwide), liver transplantation and death. It is now 40 years since development of the first plasmatic vaccine which has been proven to prevent (liver) cancer.
To update firstly the molecular and epidemiological aspects of HBV-related HCC and its natural history together with the benefits associated with viral suppression and secondly the safety, immunogenicity and efficacy of HBV vaccination.
Analysis of recent published data regarding HBV replication, anti-viral treatments and vaccination.
The nuclear HBV replication cycle in the hepatocyte combines two limiting steps to achievement of HBV cure during chronic infection: the formation of a minichromosome, the supercoiled cccDNA, and host-genome integration of HBV DNA which triggers direct viral hepatocarcinogenesis. Even if specific anti-viral treatments significantly reduce viral replication, they decrease but do not cancel the risk of liver-related events in contrast with the prevention of HBV through HBV vaccination.
To achieve the 2030 viral hepatitis elimination plan, the HBV vaccine is a priority tool for achieving the sustainable development goals of the World Health Organization.
慢性乙型肝炎病毒（HBV）感染会导致肝硬化及其并发症的高风险，这些并发症包括肝硬化失代偿、肝细胞癌（HCC，全球癌症相关死亡的第四大常见原因）、肝移植和死亡。自第一种被证明可预防（肝脏）癌症的血浆疫苗研发至今已有40年。
首先更新HBV相关HCC的分子和流行病学方面及其自然史，以及与病毒抑制相关的益处；其次更新HBV疫苗的安全性、免疫原性和有效性。
分析近期发表的有关HBV复制、抗病毒治疗和疫苗接种的数据。
肝细胞中的核HBV复制周期结合了慢性感染期间实现HBV治愈的两个限制步骤：微型染色体（超螺旋cccDNA）的形成以及HBV DNA的宿主基因组整合，后者会引发直接的病毒致癌作用。即使特定的抗病毒治疗可显著降低病毒复制，但与通过HBV疫苗预防HBV不同，它们会降低但不会消除肝脏相关事件的风险。
为实现2030年消除病毒性肝炎计划，HBV疫苗是实现世界卫生组织可持续发展目标的优先工具。
