TREAT-B: Simple Low-Cost Diagnostic Score for When to Treat Hepatitis B.
TREAT-B: Simple Low-Cost Diagnostic Score for When to Treat Hepatitis B.
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TREAT-B：关于何时治疗乙型肝炎的简单低成本诊断评分。
DOI：
10.1093/cid/ciaa1820
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Vinikoor,MichaelJ
中科院分区：
文献类型：
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作者：
Vinikoor,MichaelJ
在全球范围内，病毒性肝炎每年造成的死亡人数超过人类免疫缺陷病毒、结核病或疟疾。大多数肝炎死亡（每年约100万）是由于慢性B型肝炎病毒（HBV）感染，影响2.92亿人。在慢性HBV（PLHBV）感染者中，死亡率可以通过早期诊断和治疗来预防。高度准确的测试，包括快速点护理（POC）检测，可用于诊断感染。有7种美国食品和药物管理局批准的治疗方法，其中替诺福韦和恩替卡韦，两种核苷类似物（NA），是首选的一线选择。尽管存在经过验证的诊断和治疗方法，但存在巨大的实施差距。在全球范围内，只有10.5%的PLHBV知道自己的感染，其中只有16.7%的人在接受治疗，在HBV流行的低收入和中等收入国家（LMIC），指标要差得多[1]。这些差距主要源于缺乏认识、耻辱和歧视、经济限制和政治意愿不足。由于病毒复杂的自然史，解决HBV治疗差距也具有挑战性。HBV感染涉及肝脏中病毒感染与宿主免疫应答之间的动态和不完全理解的相互作用。由于动物模型的局限性和人类研究中肝脏取样的有限使用，基本知识差距仍然存在。慢性HBV感染通常在肝硬化和/或肝细胞癌发作前数十年内无症状。当确诊时，评估PLHBV是否需要治疗。这需要评估纤维化/肝硬化，使用非侵入性测试，如瞬时弹性成像或活检，以及HBV病毒载量（VL）和丙氨酸氨基转移酶（ALT）水平的血液测试，以及其他标志物，包括HIV测试（所有HIV-HBV合并感染的人都有资格接受治疗）。那些肝硬化，通常存在于5%至10%，通常有资格立即治疗。根据他们的结果，非结核性PLHBV被分类为几种临床表型之一。当临床表型预示着HBV相关死亡风险升高时，建议开始治疗。通常，10%至30%的人有资格接受基于肝硬化或
Globally, viral hepatitis is responsible for more annual deaths than human immunodeficiency virus, tuberculosis, or malaria. The majority of hepatitisdeaths (~ 1 million per year) are due to chronic hepatitis B virus (HBV) infection, which affects 292 million people. In people living with chronic HBV (PLHBV), mortality can be prevented through early diagnosis and treatment. Highly accurate tests, including rapid pointof-care (POC) assays, are available to diagnose the infection. There are 7 US Food and Drug Administration–approved therapies, with tenofovir and entecavir, two nucleoside analogs (NA), being the preferred first-line options. Despite the existence of proven diagnostics and therapeutics, massive implementation gaps exist. Globally, only 10.5% of PLHBV are aware of their infection and, of those, only 16.7% are on therapy, with substantially worse indicators in low-and middle-income countries (LMIC) where HBV is endemic [1]. These gaps stem broadly from a lack of awareness, stigma and discrimination, economic constraints, and insufficient political will.Addressing the HBV treatment gap is also challenging because of the virus’ complex natural history. HBV infection involves dynamic and incompletely understood interactions between viral infection in the liver and host immune responses. Fundamental knowledge gaps persist because of limitations of animal models and limited use of liver sampling in human studies. Chronic HBV infection is typically asymptomatic for decades before the onset of cirrhosis and/or hepatocellular carcinoma. When diagnosed, PLHBV are evaluated for the need of therapy. This entails assessment for fibrosis/cirrhosis, with a noninvasive test such as transient elastography or a biopsy, and blood tests for the HBV viral load (VL) and alanine aminotransferase (ALT) level, among other markers including an HIV test (all persons with HIV-HBV coinfection are eligible for therapy). Those with cirrhosis, usually present in 5% to 10%, are generally eligible for immediate therapy. Noncirrhotic PLHBV are categorized, based on their results, into one of several clinical phenotypes. Therapy initiation is recommended when the clinical phenotype portends an elevated risk of HBV-related mortality. Usually, 10% to 30% are eligible for therapy based on cirrhosis or