[Clinical significance and management strategies of low-level viremia during the treatment of chronic hepatitis B]

Zhonghua Gan Zang Bing Za Zhi. 2021 Dec 20;29(12):1139-1143. doi: 10.3760/cma.j.cn501113-20211122-00567.
[Article in Chinese]

Abstract

Chronic hepatitis B and its related complications seriously endanger the lives and health of our country people. Although the first-line nucleos(t)ide analogs such as entecavir, tenofovir disoproxil fumarate and tenofovir alafenamide fumarate can inhibit virus replication to a certain extent, delay or prevent disease progression, and reduce the incidence of hepatitis B-related liver cancer, but in clinical practice, HBV DNA positivity is still detected continuously or intermittently in the serum of some patients. Therefore, low-level viremia has received widespread attention and triggered discussion, and has become the difficulties and hotspot of antiviral treatment of chronic hepatitis B. This article summarizes and discusses the definition and incidence in line with the main guidelines and studies, impact of disease control and clinical prognosis, and the current treatment options in order to provide definite reference for the management of low-level viremia during antiviral therapy in patients with chronic hepatitis B.

慢性乙型肝炎及相关并发症严重危害我国人民的生命健康。尽管恩替卡韦、富马酸替诺福韦酯和富马酸丙酚替诺福韦等一线核苷(酸)类似物能在一定程度上抑制病毒复制,延缓或阻止疾病进展,降低乙型肝炎相关肝癌发生率,但在临床实践中部分患者血清中仍持续或间歇地检测出HBV DNA阳性。由此,低病毒血症被大家广泛关注和讨论,成为当下慢性乙型肝炎抗病毒治疗的难点和热点。因此,本文讨论了各大指南和研究中低病毒血症的定义和发生率,总结了其对慢性乙型肝炎患者疾病控制和临床预后的影响,汇总了目前低病毒血症患者的治疗方案,以期为抗病毒治疗过程中伴低病毒血症患者的管理提供一定参考。.

Keywords: Antiviral therapy; Chronic hepatitis B; Low-level viremia; Nucleos(t)ide analogs.

MeSH terms

  • Adenine / therapeutic use
  • Antiviral Agents / therapeutic use
  • Hepatitis B virus
  • Hepatitis B, Chronic* / drug therapy
  • Hepatitis B, Chronic* / epidemiology
  • Humans
  • Tenofovir / therapeutic use
  • Treatment Outcome
  • Viremia / drug therapy

Substances

  • Antiviral Agents
  • Tenofovir
  • Adenine