Li Ya-Ping, Liu Chen-Rui, He Ling, Dang Shuang-Suo
Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
World J Hepatol. 2024 Jun 27;16(6):900-911. doi: 10.4254/wjh.v16.i6.900.
Achievement of a 'clinical cure' in chronic hepatitis B (CHB) implies sustained virological suppression and immunological control over the infection, which is the ideal treatment goal according to domestic and international CHB management guidelines. Clinical practice has shown encouraging results for specific patient cohorts using tailored treatment regimens. These regimens incorporate either nucleos(t)ide analogs, immunomodulatory agents such as pegylated interferon α, or a strategic combination of both, sequentially or concurrently administered. Despite these advancements in the clinical handling of hepatitis B, achieving a clinical cure remains elusive for a considerable subset of patients due to the number of challenges that preclude the realization of optimal treatment outcomes. These include, but are not limited to, the emergence of antiviral resistance, incomplete immune recovery, and the persistence of covalently closed circular DNA. Moreover, the variance in response to interferon therapy and the lack of definitive biomarkers for treatment cessation also contribute to the complexity of achieving a clinical cure. This article briefly overviews the current research progress and existing issues in pursuing a clinical cure for hepatitis B.
慢性乙型肝炎（CHB）实现“临床治愈”意味着对感染实现持续的病毒学抑制和免疫控制，这是国内外CHB管理指南所设定的理想治疗目标。临床实践表明，针对特定患者群体采用量身定制的治疗方案可取得令人鼓舞的效果。这些方案包括核苷（酸）类似物、聚乙二醇化干扰素α等免疫调节药物，或两者的策略性联合使用，序贯或同时给药。尽管乙型肝炎临床治疗取得了这些进展，但由于存在诸多阻碍实现最佳治疗效果的挑战，相当一部分患者仍难以实现临床治愈。这些挑战包括但不限于抗病毒耐药性的出现、免疫恢复不完全以及共价闭合环状DNA的持续存在。此外，干扰素治疗反应的差异以及缺乏明确的停药生物标志物也增加了实现临床治愈的复杂性。本文简要概述了目前在追求乙型肝炎临床治愈方面的研究进展和存在的问题。
