Antiviral Therapy for Chronic Hepatitis B

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1 Health Research Vol. 31 No. 3 Jun DOI /j. issn R575 A Antiviral Therapy for Chronic Hepatitis B CAI Wei-min The 1 th Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang China Abstract The treatments of Chronic Hepatitis B CHB are updated constantly which have made great progress. Antiviral treatment is the fundamental treatment to Chronic Hepatitis B. This article compared the American CHB prevention norm to norms of Asia Pacific and China to discuss the indications of CHB treatment. Key words Chronic Hepatitis B antiviral therapy treatment indication DNA 1998 DNA Hepatitis B virus-dna HBV-DNA TDR

2 Hepato- cellular Carcinoma HCC SFDA Funding Competing intereate Ethical approval 11 HBV-DNA 365 < HBxAg HBxAg Hepatic stellate cells HSC 3-4 HBxAg HBxAg FDA TGF-β HSC HSC 9 Ⅰ CTGF α-sma MMP-2 TGF-β 2. 2 TGF-β 1. 3 HBV-DNA 1 AGA HBV HBV-DNA WHO /TDR ALT HBeAg HCC HBV-DNA 3 HBV-DNA HCC ALT Kumar HBsAg + 1 HBV DNA 10 5 < 10 5 HBeAg ALT HBV-DNA HBeAg 1 programmed death 1 PD-1 T AGA HBV-DNA HbeAg 2006 Keeffe HBeAb PD-1 HBV-DNA HBV-DNA HBV-DNA HBV-DNA algorithm HBV-DNA HBV-DNA HBV-DNA 6 HbeAg 7 HBV algorithm 1. 5 HBV Severi 8 HBV / HBV AASLD ALT > ULN ULN 30 U /L 19 U /L keeffe

3 3 163 A treatment algorithm by an independent panel of hepatologists in the 19 United States US Panel Hepatol 2. 3 Lok AS McMahom Hepatology HBeAg ALT 2 ULN ALT NIH DNA ALT > 1 ULN NIH NIH Ann Intern Med 16 HBeAg J Hepatology 2005 Liver Int EASL 2003 J Hepatol J Hepatol HBV-DNA HBeAg HBV-DNA 10 5 /ml ALT 2008APASL guideline for HBVmanagement Int TFV 3233 ALT ETV 0. 5 ~ 1 ULN ALT > 1 ~ 2 ULN 73. 5% ALT ULN > 40 HBV- HBsAg ALT HBeAg HBV-DNA 10 4 / ml ALT HBV HBeAg HBeAg Ⅰ ~ Ⅳ HBV-DNA > IU /ml 10 5

4 /ml HBV-DNA > IU /ml < 2000 IU /ml ALT DNA /ml HBeAg HBV-DNA /ml HBeAg > 2 ULN IFN - α HBV-DNA /ml HBeAg ALT > 2 HBV-DNA /ml ALT ULN ALT 2 ALT HBV-DNA 3. 2 ALT 2006 ALT 60 Keeffe ALT > 1 ULN ALT ALT 30 U /L 19 U ALT 10 ~ ALT 40 U /L 7 ~ 35 U /L 40 U /L ~ 65 U /L x + 2s ALT ROC ALT Prati ALT ALT 40 U /L 30 U /L SAS 95 ALT ROC 133 ALT HCV 27 ALT 30 U /L 19 U /L Lee IFN-α WHO BMI ALT 2 ULN U /L 22 U /L Dutta 25 ALT HVB-DNA ALT 63 U /L 52 U /L Dutta 35 ~ 40 ALT ALT 2007 ULN Kaplan 26 ALT ULN ALT / 30 U /L 19 U /L ALT > 40 Yuen MF 2007 S2 HBV-DNA > ALT /ml G2 / S2 HBV-DNA ALT 2005 Knodell HAI 4 G2 HBeAg ALT 40 HBV 1 /4 HBV-DNA ~ 40 U /L S2 27% 15 /55 S3 9% HBeAg HBV- G246% 25 /55 G154% ~ 1 < 0. 5 HBV- G2 / S2 DNA ALT HBV ALT 20 U /L S2 7% 3 /46 20 P < ALT ALT 28 HBV 80. 9% S2 >

5 Lok AS McMahon BJ. AASLD practice guidelines chronic hepati % > cm > 4. 0 cm Stated 2008 Update J. Clin Gastroenterol Hepatol HBV G2 / S % > 40 tis B J. Hepatology Hoofnagle JH Doo E Liang TJ Summary of a clinical reseach workshop J. Hepatology 2. 5 cm / ~ 1 / cm 20 mg 1 / FDA HCC HBV-DNA 1 Iloeje UH Yang H Su J et al. Predicting cirrhosis risk based on the level of circulating hepatits B viral load J. Gastroenterology Kumar M sarin SK Hissar S et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT J. Gastroenterology Martin-vilchez S Sanz-Cameno P Spain M et al. Hepatitis B virus HBV protein x HBx promotes hepatic stellate cells HSC activation J. Hepatology A. 4 Martin-vilchez S Sanz-Cameno P Rodriguez-Munoz Y et al. The hepatitis B virus x protein induces paracrine activations of human hepatic stellate cells J. Hepatology Evans A Riva A Cooksley H et al. Programmed death 1 expression during antiveral treatment of chronic hepatic B Impact of HBeAg seroconversion J. Hepatology Dandvi M Murray JM Lutgehetmann M et al. Virion half life in chronic hepatitis B infection is strongle correlated with levels of viremia J. Hepatology Volz T Lutgehetmann M Wacheler P et al. Impaired intrahepatitis B virus productivity contributes to low viremia in most HBeAg-negative patients J. Gastroenterology Severi T Ying C Vermeesch JR et al. Hepatitis B virus replication causes oxidativer stress in Hep AD38 liver cell J. Mal Cell Biochem J. 27. J Keeffe EB. Revised treatment algorithm for chronic hepatitis B J. GI & Hepatology News Keeffe EB Dieterich KT Han SB et al. A treatment algorithm for the management of chronic Hepatitis B Virue infection in the United Lok AS McMahon BJ. Chronic hepatitis B J. update et al. Management of hepatitis B National Institutes of Healthy. Consensus Development conference statement management of hepatitis B EB /OL http / /www. natap. org /2008 /HBV / _ 01. htm. 16 Sorrell MF Belongia EA Costa J et al. National Institutes of Health Consensus Development Conference Statement management of hepatitis B J. Ann Intern Med Tong MJ Hsien C Hsu L et al. Treatment recommendation for chronic hepatitis B An evaluation of current guidelines based on a natural history study in the united states J. Hepatiology European Association For The Study of The Liver. EASL Clinical Practice Guidelines management of chronic hepatitis B J. J Hepatol APASL J J Yun-Fan Liaw Nancy Leung Jia-Horng Kao et al. Asian-Pacific consensus statement on the management of chronic hepatitis B a 2008 update J. Hepatol Int J Prati D Taioli E Zanella A et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels J. Ann Intern Med Lee JK Shim JH Lee HC et al. Estimation of healthy upper limits for serum alanine aminotransterase in Asian populations with normal liver histology J. Heapatology Dutta A Saha C Johnson CS et al. Variability in upper limit of normal for serum alanine aminotransferase levels A statewide study J. Hepatology Kaplan MM. Alanine aminotransferase levels what's normal J. Ann Intern Med J. ibid

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2000 IU/ml χ 2 = P 0.05

2000 IU/ml χ 2 = P 0.05 2014 6 4 63 IFN-α 1b CHB 1 1 2 3 4 1. 100069 2. 302 100039 3. 430030 4. 518035 1 α 1b IFN-α 1bNAs HBeAg CHB48 159 NAs12 36HBV DNA HBeAgCHB 77 IFN-α 1b4882 NAs 4812t χ 2 48 HBeAg 21.74% 20.29% HBeAg 5.63%