Is it possible to stop nucleos(t)ide analogue treatment in chronic hepatitis B patients?

作     者：Elia Moreno-Cubero Robert T Sánchez del Arco Julia Pena-Asensio Eduardo Sanz de Villalobos Joaquín Míquel Juan Ramón Larrubia 

作者机构：Translational Hepatology UnitGuadalajara University HospitalUniversity of AlcaláGuadalajara 19002Spain Internal Medicine ServiceGuadalajara University HospitalUniversity of AlcaláGuadalajara 19002Spain Department of Biology of SystemsUniversity of AlcaláAlcaláde Henares(Madrid)28805Spain Department of Medicine and Medical SpecialtiesUniversity of AlcaláAlcaláde Henares(Madrid)28805Spain 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第17期

页      面：1825-1838页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by grants from the “Instituto de Salud Carlos Ⅲ”,Spain and the “European Regional Development Fund(ERDF),a way of making Europe”,No.PI12/00130 and No.PI15/00074 the “Gilead Spain & Instituto de Salud Carlos Ⅲ”,No.GLD14_00217 and No.GLD16_00014 

主　　题：CD8 Lamivudine Nucleos(t)ide analogues Tenofovir Chronic hepatitis B Entecavir hepatitis B virus Treatment cessation 

摘      要：Chronic hepatitis B(CHB) remains a challenging global health problem, with nearly one million related deaths per year. Nucleos(t)ide analogue(NA) treatment suppresses viral replication but does not provide complete cure of the hepatitis B virus(HBV) infection. The accepted endpoint for therapy is the loss of hepatitis B surface antigen(HBs Ag), but this is hardly ever achieved. Therefore, indefinite treatment is usually required. Many different studies have evaluated NA therapy discontinuation after several years of NA treatment and before HBs Ag loss. The results have indicated that the majority of patients can remain off therapy, with some even reaching HBs Ag seroconversion. Fortunately, this strategy has proved to be safe, but it is essential to consider the risk of liver damage and other comorbidities and to ensure aclose follow-up of the candidates before considering this strategy. Unanswered questions remain, namely in which patients could this strategy be effective and what is the optimal time point at which to perform it. To solve this enigma, we should keep in mind that the outcome will ultimately depend on the equilibrium between HBV and the host s immune system. Viral parameters that have been described as good predictors of response in HBe Ag(+) cases, have proven useless in HBe Ag(-) ones. Since antiviral immunity plays an essential role in the control of HBV infection, we sought to review and explain potential immunological biomarkers to predict safe NA discontinuation in both groups.