Souleiman Roni, Cornberg Markus
Klinik für Gastroenterologie, Hepatologie, Infektiologie, und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Zentrum für Individualisierte Infektionsmedizin (CiiM), Hannover, Deutschland.
Inn Med (Heidelb). 2024 Apr;65(4):296-307. doi: 10.1007/s00108-024-01671-w. Epub 2024 Feb 28.
Despite the availability of vaccines, hepatitis B remains a significant cause of fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. The increase in reported hepatitis B cases in Germany is attributed to factors such as immigration and the hepatitis B surface antigen (HBsAg) screening introduced in 2020 as part of health check-ups. The indication for treatment depends on various factors, including the level of hepatitis B virus (HBV) DNA and inflammatory activity. Nucleos(t)ide analogues are the preferred treatment option, but functional cure, defined as HBsAg loss, is rare. In principle, treatment with nucleos(t)ide analogues should usually be discontinued after loss of HBsAg, but can be stopped earlier under certain conditions and is currently the subject of ongoing research. Pregnancy and immunosuppression in the context of hepatitis B require special attention. In addition, a possible hepatitis D virus co-infection must always be taken into account, which is why every HBsAg-positive person should be tested for anti-HDV. Since 2020, the entry inhibitor bulevirtide has become a new treatment option alongside pegylated interferon alfa, which represents a significant advance in the treatment landscape.
尽管有疫苗可用，但在全球范围内，乙型肝炎仍然是暴发性肝炎、肝硬化和肝细胞癌的重要病因。德国报告的乙型肝炎病例增加归因于移民以及2020年作为健康检查一部分引入的乙型肝炎表面抗原（HBsAg）筛查等因素。治疗指征取决于多种因素，包括乙型肝炎病毒（HBV）DNA水平和炎症活动。核苷（酸）类似物是首选的治疗选择，但功能性治愈（定义为HBsAg消失）很少见。原则上，核苷（酸）类似物治疗通常应在HBsAg消失后停药，但在某些情况下可以提前停药，目前这是正在进行的研究课题。乙型肝炎患者的妊娠和免疫抑制需要特别关注。此外，必须始终考虑可能的丁型肝炎病毒合并感染，这就是为什么每个HBsAg阳性者都应检测抗HDV。自2020年以来，进入抑制剂布列韦肽已成为聚乙二醇化干扰素α之外的一种新的治疗选择，这代表了治疗领域的重大进展。
