Three key problems of antiviral treatment of hepatitis B

Three key problems of antiviral treatment of hepatitis B
Have already reached common understanding in antiviral treatment of hepatitis B at present of the Liu 's of chief physician of Beijing Temple of Earth hospital. What kind of patient needs to treat? Which kind of drug therapy is chosen? When to stop treating? It is the question that every doctor and patient care about most, it is the hot topic of preventing and curing guide of chronic hepatitis B both at home and abroad too. Chronic hepatitis B develops and duplicates obvious relevance with hepatitis B and virus. It is verified that Taiwan REVEAL studies, hepatitis B virus DNA (HBVDNA) Load and measure it with liver cirrhosis, liver cell cancer (HCC) Emergence positive correlation. It verifies, it is a risky factor of the primary hepatocarcinoma that e antigen is positive to otherwise study. So inhibit hepatitis B and virus from duplicating effectively, inhibit measure and can not react (PCR) HBVDNA (real-time polymerase chaining continuously France is equivalent to 50- 90 copies / ml) ,Realize e antigenic serum is changed, may delay disease progress, will lower the emergence of liver cirrhosis, hepatocarcinoma, lengthen patient's life, improve the quality of surviving. Have already reached common understanding in antiviral treatment of the chronic hepatitis B at present. What kind of patient needs to treat? Which kind of drug therapy is chosen? When to stop treating? It is the question that every doctor and patient care about most, it is American hepatopathy that is studied, learnt(AASLD) too , the Asian-Pacific liver is studied and learnt(APASL) , the European liver is studied and learnt(EASL) Hot topic of the guide to the prevention and cure of slow hepatitis B. What patients need to treat 1? The views of a plurality of guides are unanimous in the world, define the chronic hepatitis B diagnosed, it is a target crowd against virus treatment; Patient, having no activity to carry the state patient and does not need to treat temporarily that those are in immunity to tolerate one, but should follow up a case by regular visits to regularly. Still in immunity the patient tolerating the state as to age> and 40 years old, patient that HBVDNA and ALT fluctuated, and the patient with history of HCC family, proposes doing the liver and organizing the pathology inspection. Until the intersection of liver and inflammation and fiber take intensity determine, treat, in liver live examine, brief on / severe inflammation and/or fiber take, need to treat; It is depleted and losing the patient that compensating liver cirrhosis, chronic hepatitis acute worsening, compensating liver cirrhosis HBVDNA activity duplicated as to the acute liver, treat immediately. Should pay attention to several questions while assessing the infeted of chronic HBV needs to treat, ALT is though very important horizontally, it is not enough to judge what patients treat the target, low-level ALT progressive hepatopathy, should analyze individuals. The threshold value of relevant HBVDNA is not clear to develop with liver disease at present, low-level HBVDNA has danger of developing into liver cirrhosis and liver cell cancer too, ALT level of the infeted of chronic HBV answers and appraises with serum HBVDNA level and age synthetically, evaluate interests and risk of the treatment, to confirm and begin the patient against virus treatment while being difficult, should make liver and organize examining alive. Which kind of drug therapy is 2 chosen? The ones that are listed in our country at present resist HBV medicine include two big classes, namely interferon medicine and nucleoside (acid) Kind medicine ( Make Lammi, ester, kindness Wei of good fortune of A Germany for card Wei, for making than) . Interferon acts on more extensively, have function such as immune adjustment, resisting the fiber besides being antiviral, e serum conversion ratio of antigen higher than nucleoside ' Acid) Kinds of medicine is at issue, ALTs high of compensating, liver function in what has been is it young to suitable fored, in HBVDNAs low-level and hope to last course of treatment the patients of the treatmentses short-term, but its tolerance is bad, there are many side effects, should treat under the guidance of experienced specialist, monitor regularly. The course of treatment is generally 48 weeks. Nucleoside( Acid) One kind of medicines, mainly through inhibiting virus DNA polymerase and working against duplicating enzyme, the inhibitory activity of HBVDNA is stronger than interferon, but e antigenic serum conversion ratio is relatively low. 4 plants the nucleoside ' Acid) One kind of medicine characteristics is different, should be chosen rationally by the specialist according to the patient's individual situation. In U.S.A. and Europe, , do not recommend using medicine as a gleam of. Include our country in Asian-Pacific area, the intersection of Lammi and it makes antiviral function to be betterrer and very fast, the price is low, security is good, treat the materials of different HBV relevant diseases intactly, still resist a gleam of of HBV treatment and use medicine at present. Good fortune of A Germany ester Wei able to bear medicine incidence low, medicine have able to bear medicines alternately with other nucleoside, it is a kind of choice of able to bear the medicine patient to jointly treat with other nucleoside medicines at presenting. Antiviral the intersection of function and weak and kidney toxicity main shortcoming their, substitute good fortune of A Germany ester Wei progressively already for Wei, of promise, in America and Europe. Kindness inhibit HBVDNA from apply for the intersection of card and Wei strong fast, able to bear the intersection of medicine and rate in four (sour) nucleoside Kinds of medicine most low, suitable for relatively quantity high to need nucleoside that inhibit from fast badly cure the disease people for the first time year such as virus, the intersection of Lammi and able to bear, leave the intersection of card and Wei on kindness behind the medicine definitely, not only dosage take, apt to happen, able to bear medicine, it is not Lammi the makes or in order to be able to bear the ideal choice of medicine more definitely than the. The is able to bear medicines and lead and is lower than Lammi the to fix definitely for inhibiting virus efficiency from being superior to Lammi more definitely than the, leave the intersection of card and Wei and good fortune of A Germany ester Wei on kindness, have, able to bear medicine (YMDD) alternately definitely with the intersection of Lammi and ,Monitor creatine kinase (CK) in the treatment ,Do not propose uniting application with interferon. When will 3 stop treating? Nucleoside( Acid) The analog treatment should lengthen and treat for 6~12 months and consolidate curative effect after obtaining e antigenic serology to change, side can park consideration medicine, for HBeAg (-) Patient, that antigenic serology changes to obtain e HBeAg (+) Patient, liver cirrhosis patient (including the liver cirrhosis patient who has already changed e antigenic serum) Should accept the long-term treatment. Jointly treat relevantly, propose in AASLD slow hepatitis B guide: Nucleoside( Acid) One kind of medicines is jointly treated and can be used for being able to bear a medicine patient and lose a compensating hepatopathy patient. EASL conference president Marcellin professor points out at the annual meeting of hepatopathy of 2009 Asian-Pacific area: Future will be the union application of different medicines. And should meet the following several points: Different positions that act on HBVDNA and duplicate; Have strong antiviral function; Good security; Can make the patient replied in the limited course of treatment enduringly, the union scheme which gathers interferon of ethylene glycol and potent nucleoside medicine is worth further studying.

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