Hepatitis B treatment: Current best practices, avoiding resistance.
Hepatitis B treatment: Current best practices, avoiding resistance.
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DOI：
10.3949/ccjm.76.s3.04
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发表时间：
2009-05-01
影响因子：
6.1
通讯作者：
Gish, Robert G
中科院分区：
文献类型：
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作者：
Gish, Robert G
所有乙型肝炎病毒 (HBV) DNA 呈阳性的患者均应考虑接受抗病毒治疗。抑制 HBV DNA 的效力是选择一线治疗的主要因素；恩替卡韦和替诺福韦是迄今为止最有效且耐药率最低的核苷和核苷酸类似物。病毒阴性可能会减少肝衰竭的发生和移植的需要，尽管这些益处需要前瞻性地证明。乙型肝炎表面抗原的丧失或血清转化可能代表一种新的治疗范例。对治疗产生耐药性可能导致病毒学突破和严重的临床后果。使用最有效的药物作为一线治疗可降低耐药风险；但如果出现耐药性，建议添加额外的药物，而不是改用另一种疗法。
All patients who are positive for hepatitis B virus (HBV) DNA should be considered for antiviral treatment. Potency in suppressing HBV DNA is the main factor in the choice of first-line therapy; entecavir and tenofovir constitute the most potent nucleoside and nucleotide analogues to date with the lowest rates of resistance. Viral negativity may reduce the development of liver failure and the need for transplant, although these benefits need to be demonstrated prospectively. Loss of hepatitis B surface antigen, or seroconversion, may represent a new treatment paradigm. The development of resistance to therapy can result in virologic breakthrough and serious clinical consequences. Use of the most potent agents as first-line therapy lowers the risk of resistance; but if resistance develops, adding an additional agent, rather than switching to another therapy, is advised.