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乙型肝炎治疗与预防的进展

Advances in treatment and prevention of hepatitis B.

作者信息

Shah Niraj James, Aloysius Mark M, Sharma Neil Rohit, Pallav Kumar

机构信息

Department of Internal Medicine, Digestive Disease, University of Mississippi Medical Center, Jackson, MS 39216, United States.

Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States.

出版信息

World J Gastrointest Pharmacol Ther. 2021 Jul 5;12(4):56-78. doi: 10.4292/wjgpt.v12.i4.56.

Abstract

Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.

摘要

慢性乙型肝炎(CHB)仍然是全球发病和死亡的重要原因。科学家、临床医生、制药公司和卫生组织投入了大量的智力和财力资源来寻找治愈方法、提高免疫接种率并减轻全球CHB负担。包括疾病控制中心、国立卫生研究院、美国肝病研究协会(AASLD)、欧洲肝病研究协会(EASL)、亚太肝病研究协会(APASL)和世界卫生组织在内的国家和国际卫生相关组织定期发布疾病预防和治疗建议。我们对EASL、AASLD、APASL和台湾肝病研究协会的最新指南进行了回顾,发现绝大多数被引用的研究发表于2018年之前。我们回顾了2018年以后发表的乙型肝炎相关文献,以确定近期的进展和当前的障碍,这些进展和障碍可能会指导未来消除乙型肝炎的努力方向。我们对乙型肝炎病毒生命周期的理解取得了突破,由此带来的药物研发令人鼓舞,仍有很大的进一步发展空间。来自高风险人群的数据仍然稀少,这些人群最容易受到乙型肝炎感染和再激活的毁灭性影响。采用系统方法、优化实验模型、识别和验证下一代生物标志物以及精确调节人体免疫反应对于未来的创新至关重要。在可预见的未来,新的治疗方法可能会补充传统疗法,而不是取代它们。最重要的是,必须优先对CHB相关人群健康挑战进行务实管理,以取得实际效果。

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