Chronic Viral Hepatitis: Current Management and Future Directions
Chronic Viral Hepatitis: Current Management and Future Directions
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DOI：
10.1002/hep4.1480
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发表时间：
2020-01-20
影响因子：
5.1
通讯作者：
Reau, Nancy S.
中科院分区：
文献类型：
--
作者：
Do, Albert;Reau, Nancy S.
在过去的十年中，识别和管理病毒性肝炎的策略发生了转变，最引人注目的是丙型肝炎病毒从一种主要的慢性疾病转变为一种可治愈的疾病，通过直接作用的抗病毒治疗，广泛人群可以获得。最近，丙型肝炎病毒的负担转移到年轻患者静脉注射药物的使用已经形成了筛查建议。未来的工作重点是有效的筛查、与护理的联系、治疗的启动和治愈后的管理，这将使各国能够努力实现消除病毒性肝炎这一主要公共卫生威胁的目标。与此同时，使用具有高耐药性屏障的口服核苷（酸）疗法来管理B型肝炎病毒也取得了进展。然而，即使使用抑制性抗病毒治疗，在肝细胞核内病毒遗传持久性的情况下，病毒学治愈仍然难以捉摸。未来的方向包括“治愈”的精确定义，新的生物标志物，以及针对病毒致病和复制途径中多个途径的治疗方法的开发。在丁型肝炎感染的管理方面也取得了进展。这篇综述总结了疾病特征的最新进展，相关的受影响人群，以及我们对这些感染管理的理解的变化。我们还讨论了病毒性肝炎管理的未来方向，包括抗病毒治疗前后管理相关问题的讨论。结论：我们总结了病毒性肝炎的识别和管理方面的最新进展，这些进展有可能显着减少疾病负担，从而减少相关的肝脏相关并发症。然而，需要进一步开展工作，以充分查明和管理这些疾病。
The past decade has seen transformation in the strategies for identifying and managing viral hepatitis, most dramatically the transformation of hepatitis C virus from a mostly chronic affliction to a curable disease that is accessible to wide populations through direct-acting antiviral therapies. More recently, shifting of hepatitis C virus burden to younger patients driven by intravenous drug use has shaped screening recommendations. Future work focusing on effective screening, linkage to care, treatment initiation, and post-cure management will allow countries to work toward meeting goals of eliminating viral hepatitis as a major public health threat. Concurrently, hepatitis B virus has also seen advances in management using oral nucleos(t)ide therapies with high-resistance barriers. However, virologic cure remains elusive in the setting of viral genetic persistence within the hepatocyte nucleus, even with suppressive antiviral therapy. Future directions include a refined definition of "cure," new biomarkers, and development of therapies targeting multiple pathways in the viral pathogenic and replication pathway. Progress is additionally being made on the management of hepatitis D infection. This review summarizes the recent evolution in disease characteristics, associated affected population, and changes in our understanding of management for these infections. We also discuss future directions in the management of viral hepatitis, including discussion on issues related to management before and after antiviral therapy. Conclusion: We summarize recent advances in the identification and management of viral hepatitis, which hold the potential to markedly reduce disease burden and therefore associated liver-related complications. However further work is needed to adequately identify and manage these diseases.