Liver Research Unit, Linkou Medical Center, Chang Gung University, Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan.
Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Semin Liver Dis. 2021 Aug;41(3):349-357. doi: 10.1055/s-0041-1729973. Epub 2021 Jun 28.
Antiviral therapy has greatly improved the survival and reduced the incidence of adverse liver events such as hepatic decompensation and hepatocellular carcinoma in chronic hepatitis B patients with cirrhosis (hepatitis B virus [HBV]-cirrhosis). However, hepatitis B surface antigen loss, regarded as the ultimate goal of therapy or functional cure, was rarely achieved during long-term indefinite nucleos(t)ide analogues (Nuc) treatment. Emerging issues such as medication adherence and loss-to-follow-up may lead to increased risk of hepatic decompensation, even catastrophic life-threatening events. Studies have shown that finite therapy is feasible and reasonably safe, even in patients with HBV-cirrhosis. This review critically assesses the scientific evidence of the pros and cons for finite Nuc therapy in HBV-cirrhosis and proposes how to stop Nuc therapy and monitor the off-therapy patients. It also proposes the perspective and unsolved issues to be investigated in the future.
抗病毒治疗极大地改善了生存状况，降低了慢性乙型肝炎肝硬化患者（乙型肝炎病毒 [HBV]-肝硬化）不良肝脏事件（如肝失代偿和肝细胞癌）的发生率。然而，在长期无限制核苷（酸）类似物（Nuc）治疗期间，很少能实现乙型肝炎表面抗原丢失，这被视为治疗的最终目标或功能性治愈。药物依从性和失访等新出现的问题可能会导致肝失代偿风险增加，甚至发生危及生命的灾难性事件。研究表明，有限疗程治疗是可行的，也是合理安全的，即使是在 HBV-肝硬化患者中也是如此。本综述批判性地评估了有限 Nuc 治疗 HBV-肝硬化的优缺点的科学证据，并提出了如何停止 Nuc 治疗和监测停药患者的建议。它还提出了未来需要研究的观点和未解决的问题。
