Abstract:
:Better understanding of hepatitis B virus (HBV) replication, natural history and the immunopathogenesis of chronic hepatitis B, together with the introduction of effective agents with different mechanisms of action are the basis for better therapeutic strategies against chronic hepatitis B. Among currently available drugs, interferon-alpha and thymosin-alpha1 have only modest efficacy (approximately 40% vs 9-20% in controls). In the past decade, lamivudine has dominated in the treatment of chronic HBV infection because it is easy to use, safe, and is effective in terms of hepatitis B e antigen and/or HBV-DNA loss, ALT normalization, and improvement in histology. The response rate increases with increasing pretherapy alanine aminotransferase (ALT) levels, suggesting that patients with stronger endogenous immune response against HBV have a better response to direct antiviral agents. Lamivudine is also beneficial in decompensated cirrhotics with HBV replication. Hepatitic flares may occur after stopping lamivudine therapy in nonresponders and also in responders. Therefore, prolonged therapy is usually required. However, tyrosine-methionine-aspartate-aspartate (YMDD) mutations conferring resistance to lamivudine start to emerge after 6-9 months of therapy, and hepatitis flare, even decompensation, may develop after viral breakthrough. Thus the benefits of long-term lamivudine therapy must be balanced against the concern about YMDD mutations and the durability of treatment response. Adefovir dipivoxil, entecavir, emtricitabine, clevudine and other nucleoside/ nucleotide analogues have shown encouraging results and some agents appear effective in patients with YMDD mutants. Further development of new drugs and new strategies may help to improve treatment in the new century.
journal_name
J Viral Hepatjournal_title
Journal of viral hepatitisauthors
Liaw YFdoi
10.1046/j.1365-2893.2002.00388.xsubject
Has Abstractpub_date
2002-11-01 00:00:00pages
393-9issue
6eissn
1352-0504issn
1365-2893pii
388journal_volume
9pub_type
杂志文章,评审abstract::Little is known about engagement and retention in care of people diagnosed with chronic hepatitis C (HCV) in England. Establishing a cascade of care informs targeted interventions for improving case finding, referral, treatment uptake and retention in care. Using data from the sentinel surveillance of blood-borne viru...
journal_title:Journal of viral hepatitis
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-07-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1365-2893.1994.tb00114.x
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pub_type: 杂志文章,meta分析
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更新日期:2008-02-01 00:00:00
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journal_title:Journal of viral hepatitis
pub_type: 杂志文章
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更新日期:2018-09-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:2007-11-01 00:00:00
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journal_title:Journal of viral hepatitis
pub_type: 杂志文章
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更新日期:2020-07-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2020-04-01 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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pub_type: 杂志文章
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