Treatment of HBeAg-negative chronic hepatitis B

被引:61
作者
Hadziyannis, SJ
Papatheodoridis, GV
Vassilopoulos, D
机构
[1] Henry Dunant Hosp, Dept Med & Hepatol, Athens 11526, Greece
[2] Hippokrateion Hosp, Acad Dept Med 2, Athens, Greece
关键词
chronic hepatitis B; antiviral therapy; interferon-alfa (IFN-alpha); nucleoside analogues; viral resistance;
D O I
10.1055/s-2003-37584
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The goals of therapy in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) are to abolish or efficiently suppress viral replication, which represents the main determinant of underlying liver necroinflammation and fibrosis. Currently available agents include interferon-alfa (IFN-alpha), lamivudine, and soon adefovir dipivoxil. A greater than or equal to 12-month course of IFN-alpha treatment or retreatment achieves sustained biochemical responses in 15 to 25% of patients with eventual hepatitis B surface antigen (HBsAg) loss and anti-HBs development in a proportion of them. Lamivudine induces initial virologic and biochemical responses in 70 to 90%, but breakthroughs due to lamivudine-resistant mutants accumulate with continuation of therapy and thus only one third of patients may remain in remission after the third year of therapy. Adefovir dipivoxil also achieves on-therapy responses in the majority of cases. Adefovir dipivoxil and entecavir appear to be effective against lamivudine-resistant strains. Many other antiviral agents and immunomodulatory approaches are currently evaluated for CHB, but, besides IFN-alpha, none has yet been convincingly shown to induce sustained off-therapy responses.
引用
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页码:81 / 88
页数:8
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