免疫耐受期乙型肝炎病毒感染者的抗病毒治疗策略——全治的最后一公里

Strategies for hepatitis B virus-infected patients in the immune-tolerant phase:complete therapy at the last mile

乙型肝炎大多是慢性进展性疾病,如果没有得到及时有效治疗,疾病会缓慢进展为肝硬化、肝衰竭或肝细胞癌。因此,只要病毒阳性就应该进行抗病毒治疗,即"全治"策略。按照我国《慢性乙型肝炎防治指南(2022年版)》抗病毒适应证,仅仅处于免疫耐受期的感染者没有推荐立即抗病毒治疗,主要是这部分感染者病情较轻,且抗病毒治疗疗效欠佳。现将针对为什么免疫耐受期乙型肝炎病毒感染是"全治"最后一公里的相关问题进行探讨,聚焦免疫耐受期疾病特点及其抗病毒治疗策略。

Hepatitis B is mostly a chronic,progressive disease that,if not treated promptly and effectively,can slowly progress to cirrhosis,liver failure,or hepatocellular carcinoma.Therefore,antiviral therapy,i.e.,a"complete therapy"strategy,should be started as long as the virus is positive.Immediate antiviral treatment is not recommended for infected patients who are only in the immune-tolerant phase,mainly because of the milder conditions and poor antiviral therapy efficacy,according to antiviral indications in China's Guidelines for the Prevention and Treatment of Chronic Hepatitis B(2022 Version).The relevant issues of why hepatitis B virus infection in the immune-tolerant phase is the last mile of"complete therapy,"with an emphasis on the disease’s characteristics and antiviral treatment strategies,are discussed here.