Management of chronic hepatitis B infection: Current treatment guidelines, challenges, and new developments
Management of chronic hepatitis B infection: Current treatment guidelines, challenges, and new developments
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DOI：
10.3748/wjg.v20.i20.6262
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发表时间：
2014-05-28
影响因子：
4.3
通讯作者：
Yu, Jun
中科院分区：
文献类型：
--
作者：
Tang, Ceen-Ming;Yau, Tung On;Yu, Jun
慢性B型肝炎（CHB）病毒感染是一个全球性的公共卫生问题，影响着全球4亿多人。临床范围很广，从亚临床非活动性携带状态到进行性慢性肝炎、肝硬化、失代偿和肝细胞癌。然而，B型肝炎病毒（HBV）相关慢性肝病的并发症可能会减少病毒抑制。目前的国际指南推荐使用聚乙二醇干扰素、恩替卡韦或替诺福韦作为CHB感染的一线治疗，但对个体患者的最佳治疗仍有争议。治疗的适应症是有争议的，越来越多的证据表明，HBV基因分型，以及一系列的治疗测量的B型肝炎表面抗原和HBV DNA动力学应用于预测抗病毒治疗的反应。通过延长治疗持续时间和使用联合治疗，也可增加获得持续病毒学应答的可能性。因此，CHB的治疗模式不断发展。本文总结了不同的治疗适应症，并系统地回顾了各种抗病毒药物疗效的证据。它进一步讨论了当前指南的缺点，在HBV耐药株中使用补救治疗，并强调了正在进行的新兴疗法的有希望的临床试验。这个简明的概述提出了一个更新的实用方法来指导慢性乙型肝炎的临床管理。(C)2014百世登出版集团股份有限公司All rights reserved.
Chronic hepatitis B (CHB) virus infection is a global public health problem, affecting more than 400 million people worldwide. The clinical spectrum is wide, ranging from a subclinical inactive carrier state, to progressive chronic hepatitis, cirrhosis, decompensation, and hepatocellular carcinoma. However, complications of hepatitis B virus (HBV)-related chronic liver disease may be reduced by viral suppression. Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial. The indications for treatment are contentious, and increasing evidence suggests that HBV genotyping, as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response. The likelihood of achieving a sustained virological response is also increased by extending treatment duration, and using combination therapy. Hence the paradigm for treatment of CHB is constantly evolving. This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of HBV, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of CHB. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.