慢性乙型肝炎功能性治愈不是梦

庄辉

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临床肝胆病杂志 ›› 2025, Vol. 41 ›› Issue (1) : 2-6. DOI: 10.12449/JCH250101
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慢性乙型肝炎功能性治愈不是梦

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Functional cure of chronic hepatitis B is not a dream

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摘要

慢性乙型肝炎功能性治愈的定义是在停止抗病毒治疗后至少24周,HBsAg<0.05 IU/mL,血清HBV DNA<10 IU/mL。这需要抑制HBV复制、降低病毒抗原产生,同时恢复对HBV感染的免疫应答。约30%~50%接受核苷(酸)类似物治疗并经严格选择的慢性乙型肝炎患者,加用或单用聚乙二醇干扰素α治疗,或经核苷(酸)类似物有限疗程治疗后HBsAg<100 IU/mL者,可获得功能性治愈。目前有40余种新的抗HBV药物和免疫调节剂正在进行临床试验。抑制HBV复制、降低病毒抗原,以及提高HBV感染免疫应答药物的联合应用,可能是慢性乙型肝炎功能性治愈的理想治疗策略。但确定最佳的联合、用药时间、用药顺序和治疗期限等尚需进一步研究。

Abstract

Functional cure of chronic hepatitis B (CHB) is defined as HBsAg<0.05 IU/mL and serum HBV DNA<10 IU/mL for at least 24 weeks after discontinuation of antiviral therapy. This requires suppression of HBV replication and reduction of viral antigen production, as well as restoration of immune response to HBV infection. About 30% — 50% of highly selected CHB patients treated with nucleos(t)ide analogues can achieve functional cure after add-on therapy or monotherapy with pegylated interferon-α or a finite course of treatment with nucleos(t)ide analogues among patients with HBsAg<100 IU/mL. At present, clinical trials are being conducted for more than 40 types of novel anti-HBV drugs and immunomodulators. The combination of drugs that inhibit viral replication, reduce antigen burden, and restore immune response to HBV infection may be an ideal strategy to achieve the functional cure of CHB. However, further studies are needed to determine the optimal drug combination, the timing and sequence of medication, and the duration of treatment.

关键词

乙型肝炎, 慢性 / 乙型肝炎病毒 / 功能性治愈 / 完全治愈 / 抗病毒药

Key words

Hepatitis B, Chronic / Hepatitis B Virus / Functional Cure / Complete Cure / Antiviral Agents

引用本文

导出引用
庄辉. 慢性乙型肝炎功能性治愈不是梦. 临床肝胆病杂志. 2025, 41(1): 2-6 https://doi.org/10.12449/JCH250101
Hui ZHUANG. Functional cure of chronic hepatitis B is not a dream[J]. Journal of Clinical Hepatol. 2025, 41(1): 2-6 https://doi.org/10.12449/JCH250101

参考文献

1
CHAI N, CHANG HE, NICOLAS E, et al. Properties of subviral particles of hepatitis B virus[J]. J Virol, 2008, 82(16): 7812-7817. DOI: 10.1128/JVI.00561-08 .
2
GANEM D, PRINCE AM. Hepatitis B virus infection: Natural history and clinical consequences[J]. N Engl J Med, 2004, 350(11): 1118-1129. DOI: 10.1056/NEJMra031087 .
3
REHERMANN B, LAU D, HOOFNAGLE JH, et al. Cytotoxic T lymphocyte responsiveness after resolution of chronic hepatitis B virus infection[J]. J Clin Invest, 1996, 97(7): 1655-1665. DOI: 10.1172/JCI118592 .
4
BONI C, LACCABUE D, LAMPERTICO P, et al. Restored function of HBV-specific T cells after long-term effective therapy with nucleos(t)ide analogues[J]. Gastroenterology, 2012, 143(4): 963-973. DOI: 10.1053/j.gastro.2012.07.014 .
5
KIM JH, GHOSH A, AYITHAN N, et al. Circulating serum HBsAg level is a biomarker for HBV-specific T and B cell responses in chronic hepatitis B patients[J]. Sci Rep, 2020, 10(1): 1835. DOI: 10.1038/s41598-020-58870-2 .
6
RINKER F, ZIMMER CL, HÖNER ZU SIEDERDISSEN C, et al. Hepatitis B virus-specific T cell responses after stopping nucleos(t)ide analogue therapy in HBeAg-negative chronic hepatitis B[J]. J Hepatol, 2018, 69(3): 584-593. DOI: 10.1016/j.jhep.2018.05.004 .
7
van BÖMMEL F, BERG T. Risks and benefits of discontinuation of nucleos(t)ide analogue treatment: A treatment concept for patients with HBeAg-negative chronic hepatitis B[J]. Hepatol Commun, 2021, 5(10): 1632-1648. DOI: 10.1002/hep4.1708 .
8
LOK ASF. Toward a functional cure for hepatitis B[J]. Gut Liver, 2024, 18(4): 593-601. DOI: 10.5009/gnl240023 .
9
GHANY MG, BUTI M, LAMPERTICO P, et al. Guidance on treatment endpoints and study design for clinical trials aiming to achieve cure in chronic hepatitis B and D: Report from the 2022 AASLD-EASL HBV-HDV treatment endpoints conference[J]. J Hepatol, 2023, 79(5): 1254-1269. DOI: 10.1016/j.jhep.2023.06.002 .
10
LI MH, YI W, ZHANG L, et al. Predictors of sustained functional cure in hepatitis B envelope antigen-negative patients achieving hepatitis B surface antigen seroclearance with interferon-alpha-based therapy[J]. J Viral Hepat, 2019, 26(): 32-41. DOI: 10.1111/jvh.13151 .
摘要
Suppl 1
11
LI MH, SUN FF, BI XY, et al. Consolidation treatment needed for sustained HBsAg-negative response induced by interferon-alpha in HBeAg positive chronic hepatitis B patients[J]. Virol Sin, 2022, 37(3): 390-397. DOI: 10.1016/j.virs.2022.03.001 .
12
YIP TCF, WONG GLH, WONG VWS, et al. Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients[J]. J Hepatol, 2018, 68(1): 63-72. DOI: 10.1016/j.jhep.2017.09.018 .
13
LOK AS, ZOULIM F, DUSHEIKO G, et al. Durability of hepatitis B surface antigen loss with nucleotide analogue and peginterferon therapy in patients with chronic hepatitis B[J]. Hepatol Commun, 2019, 4(1): 8-20. DOI: 10.1002/hep4.1436 .
14
YIP TCF, LOK ASF. How do we determine whether a functional cure for HBV infection has been achieved?[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 548-550. DOI: 10.1016/j.cgh.2019.08.033 .
15
XIE C, LIN BL, XIE DY, et al. Peginterferon alpha-2b promoted HBsAg loss in nucleos(t)ide analogue-treated patients: a large-scale real-world study (Everest Project)[J]. J Hepatol, 2026 (Revised).
16
GAO N, GUAN GW, XU GL, et al. Integrated HBV DNA and cccDNA maintain transcriptional activity in intrahepatic HBsAg-positive patients with functional cure following PEG-IFN-based therapy[J]. Aliment Pharmacol Ther, 2023, 58(10): 1086-1098. DOI: 10.1111/apt.17670 .
17
HIRODE G, CHOI HSJ, CHEN CH, et al. Off-therapy response after nucleos(t)ide analogue withdrawal in patients with chronic hepatitis B: An international, multicenter, multiethnic cohort (RETRACT-B study)[J]. Gastroenterology, 2022, 162(3): 757-771. DOI: 10.1053/j.gastro.2021.11.002 .
18
LIM SG, TEO AE, CHAN ESY, et al. Stopping nucleos(t)ide analogues in chronic hepatitis B using HBsAg thresholds: A meta-analysis and meta-regression[J]. Clin Gastroenterol Hepatol, 2024. DOI: 10.1016/j.cgh.2024.05.040 . [Online ahead of print]
19
BLOCK PD, LIM JK. Unmet needs in the clinical management of chronic hepatitis B infection[J]. J Formos Med Assoc, 2024. DOI: 10.1016/j.jfma.2024.08.020 . [Online ahead of print]
20
PETERS MG, YUEN MF, TERRAULT N, et al. Chronic hepatitis B finite treatment: Similar and different concerns with new drug classes[J]. Clin Infect Dis, 2024, 78(4): 983-990. DOI: 10.1093/cid/ciad506 .
21
YUEN MF, LIM SG, PLESNIAK R, et al. Efficacy and safety of Bepirovirsen in chronic hepatitis B infection[J]. N Engl J Med, 2022, 387(21): 1957-1968. DOI: 10.1056/NEJMoa2210027 .
22
BUTI M, HEO J, TANAKA Y, et al. Sequential Peg-IFN after bepirovirsen may reduce post-treatment relapse in chronic hepatitis B[J]. J Hepatol, 2024. DOI: 10.1016/j.jhep.2024.08.010 . [Online ahead of print]
23
Study of Bepirovirsen in nucleos(t)ide analogue-treated participants with chronic hepatitis B (B-Well 1)[R/OL]. [2024-11-16].
24
Study of Bepirovirsen in nucleos(t)ide analogue-treated participants with chronic hepatitis B (B-Well 2)[R/OL]. [2024-11-16].
25
HOU JL, XIE Q, ZHANG WH, et al. OS-030 efficacy and safety of xalnesiran with and without an immunomodulator in virologically suppressed participants with chronic hepatitis B: end of study results from the phase 2, randomized, controlled, adaptive, open-label platform study (PIRANGA)[J]. J Hepatol, 2024, 80: S26. DOI: 10.1016/S0168-8278(24)00471-9 .
26
HOU JL, ZHANG WH, XIE Q, et al. Xalnesiran with or without an immunodulator in chronic hepatitis B[J]. N Engl J Med, 2024, 391(22): 2098-2109. DOI: 10.1056/NEJMoa2405485 .
27
AGARWAL K, BUTI M, van BÖMMEL F, et al. JNJ-73763989 and bersacapavir treatment in nucleos(t)ide analogue-suppressed patients with chronic hepatitis B: REEF-2[J]. J Hepatol, 2024, 81(3): 404-414. DOI: 10.1016/j.jhep.2024.03.046 .
28
GOPALAKRISHNA H, GHANY MG. Perspective on emerging therapies to achieve functional cure of chronic hepatitis B[J]. Curr Hepatol Rep, 2024, 23(2): 241-252. DOI: 10.1007/s11901-024-00652-9 .

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