乙型肝炎特殊人群抗病毒治疗的新认识

New considerations in antiviral therapy for special populations with chronic hepatitis B

在慢性乙型肝炎人群中,合并HIV/HCV/HDV感染、儿童和青少年、妊娠妇女、慢性肾损害、应用化疗和免疫抑制剂等特殊人群的抗病毒治疗问题日益受到重视。关于乙型肝炎特殊人群的抗病毒治疗指征、药物选择及调整、抗病毒疗程等是目前临床研究的热点。近几年各大乙型肝炎防治指南均提出要规范乙型肝炎特殊人群的管理,但对该人群抗病毒治疗的推荐证据级别不高。临床工作中应结合现有的研究成果,规范管理流程,力求建立高质量的队列研究,以获得强有力的循证医学证据,更好的指导临床治疗。

Increasing attentions have been paid to the antiviral therapy for special populations with chronic hepatitis B（ CHB）,including patients co- infected with HIV,HDV,or HCV,children and adolescents,pregnant women,patients with chronic kidney diseases,and patients who require chemotherapy or immunosuppressive therapy. The indications for antiviral therapy,drug selection and adjustment,and treatment course in special populations with CHB have become the hot topics of clinical research. In recent years,all guidelines for the prevention and treatment of CHB have provided a summary of key considerations in the standardized management of these populations. However,the strength of recommendations for antiviral therapy in these populations is not high. In order to obtain a strong medical evidence for antiviral therapy in these populations,we should standardize clinical management processes and carry out high- quality cohort studies based on the previous research.