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慢性 B 型肝炎 感染症: レビュー
Lydia S Y Tang1, Emily Covert1, Eleanor Wilson1
1Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore.
JAMA
|May 2, 2018
まとめ
慢性 的 B 型肝炎 ウイルス (HBV) の 感染 は,全世界 で 数百万 人 に 影響 を 及ぼし て い ます. 抗ウイルス治療は肝臓疾患の進行を減らせるが,治癒率が低いため,無期限の治療が必要になる.
科学分野:
- ヘパトロジー
- ウイルス学
- 感染症
背景:
- 慢性的なB型肝炎ウイルス (HBV) 感染は,世界中で2億4000万人以上に影響を与えています.
- 慢性HBVの治療は15~40%の症例で肝硬変,肝不全,肝がんを引き起こす可能性があります.
研究 の 目的:
- 慢性HBVに対する現在の抗ウイルス治療の有効性と限界を検証する.
- ファーストライン治療の選択と長期的な管理戦略に関するガイドラインを提供すること.
主な方法:
- ペギル化されたインターフェロンと様々な核酸ナロゲン (ラミヴジン,アデフォビル,エンテカビル,テノフォビルディゾプロキシル,テノフォビルアラフェナミド) のレビュー
- ウイルス抑制,肝繊維症の回復,B型肝炎の表面抗原喪失率に関するデータの分析.
主要な成果:
- 抗ウイルス治療はHBVのDNA複製を抑制し,肝炎と線維症を改善します.
- 長期にわたるウイルス抑制は,線維症の回復と肝細胞癌のリスクの減少と関連しています.
- 治癒率は低 (3~12%) であり,ほとんどの患者は無期限の治療が必要である.
結論:
- 肝炎を患っている慢性HBV患者には,疾患の進行を防ぐために抗ウイルス治療が推奨されます.
- 耐性プロファイルと耐容性が古い薬に比べて優れているため,第一線療法として核酸類が好ましい.
- 慢性 HBV 管理には,通常,長期または無期限の抗ウイルス治療が必要です.
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