Department of General Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama 700-8505, Japan.
World J Gastroenterol. 2021 Nov 21;27(43):7497-7508. doi: 10.3748/wjg.v27.i43.7497.
New hepatitis B virus (HBV) infections are decreasing owing to improved antiviral therapy and increased HBV vaccination worldwide; however, the number of HBV infections remains a major cause of liver carcinogenesis. HBV triggers cytotoxic immunity to eliminate HBV-infected cells. Therefore, the HBV pathophysiology changes in persistently infected individuals depending on host immune responses and HBV DNA proliferation state. To prevent liver cirrhosis and carcinogenesis caused by HBV, it is important to treat HBV infection at an early stage. Active treatment is recommended for the immunoactive hepatitis B surface-antigen-positive and -negative phase, but not during the immune-inactive phase or immune-tolerant phase; instead, follow-up is recommended. However, these patients should be monitored through regular blood tests to accurately diagnose the immune-inactive or -tolerant phases. The treatment regimen should be determined based on the age, sex, family history of liver cancer, and liver fibrosis status of patients. Early treatment is often recommended due to various problems during the immune-tolerant phase. This review compares the four major international practice guidelines, including those from the Japanese Society of Hepatology, and discusses strategies for chronic hepatitis B treatment during the immune-tolerant, immune-inactive, and resolved phases. Finally, recommended hepatitis B antiviral therapy and follow-up protocols are discussed.
新的乙型肝炎病毒（HBV）感染由于在全球范围内提高了抗病毒治疗和 HBV 疫苗接种而减少；然而，HBV 感染的数量仍然是导致肝癌发生的主要原因。HBV 引发细胞毒性免疫以消除 HBV 感染的细胞。因此，HBV 病理生理学在持续感染的个体中根据宿主免疫反应和 HBV DNA 增殖状态而改变。为了预防 HBV 引起的肝硬化和癌变，早期治疗 HBV 感染非常重要。建议对免疫活性乙型肝炎表面抗原阳性和阴性期进行积极治疗，但在免疫非活性期或免疫耐受期不建议进行治疗；而是建议进行随访。然而，这些患者应通过定期血液检查进行监测，以准确诊断免疫非活性期或免疫耐受期。治疗方案应根据患者的年龄、性别、肝癌家族史和肝纤维化状态来确定。由于免疫耐受期存在各种问题，通常建议早期治疗。本综述比较了包括日本肝病学会在内的四个主要国际实践指南，并讨论了在免疫耐受、免疫非活性和缓解期慢性乙型肝炎治疗的策略。最后，讨论了推荐的乙型肝炎抗病毒治疗和随访方案。
