Antiviral therapy for hepatitis B: interferon or nucleoside analogue?

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Antiviral therapy is the most critical treatment for patients with chronic hepatitis B. There is evidence that antiviral therapy can inhibit

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Antiviral therapy is the most critical treatment for patients with chronic hepatitis B. There is evidence that antiviral therapy can inhibit viral replication and reduce inflammation in liver tissue, thereby reducing the risk of cirrhosis and hepatocellular carcinoma.

Currently used in antiviral therapy of CHB drugs include two kinds, one kind is interferon alpha, including interferon and interferon (PEG IFN); the other is nucleoside analogues used at present has five kinds, namely for Nuo Fuwei, entecavir, telbivudine and lamivudine, adefovir dipivoxil. So, for specific patients, choose which kind of drug treatment is more appropriate? This is to say from the advantages and disadvantages of each class of drugs.

Interferon is the first anti HBV drug used in clinical practice. Medication for subcutaneous injection, the frequency of the use of ordinary interferon for the next day, long-acting interferon once a week, the total course of treatment for 6~12 months. Interferon treatment can make 30%~40% patients with HBV-DNA negative and HBeAg seroconversion, and can make the patients with surface antigen negative 1%-3%. The efficacy of interferon, the shorter the time of infection, the better the effect, the younger than the elderly, women due to men, B genotype infection due to C genotype. Compared with the nucleoside analogues, the main advantages are: (1) interferon treatment, interferon treatment for 6 to 12 months, and nucleoside needs at least 3 to 5 years, the course is not determined; (2) lasting effect, withdrawal rebound rate is low, about 80% of the patients after withdrawal can maintain curative effect; (3) do not cause virus drug resistance. The main disadvantage is that: (1) the curative effect is relatively low; (2) the need to inject drugs, drugs need to be frozen, medication is not convenient; (3) adverse drug reactions, such as fever, white blood cells, etc.. (4) it is not suitable for patients with decompensated liver disease, such as liver cirrhosis and chronic hepatitis with high bilirubin.

Nucleoside analogues have been used in clinic since the end of 90s. Its mechanism is to interfere with the nucleotide metabolism of hepatitis B virus, directly inhibit viral replication, the way of Administration for oral administration once a day. The main advantages are: (1) oral medication, medication convenience; (2) virus inhibition ability, 60%-90% patients can reach HBV DNA negative and HBeAg seroconversion rate of about 30%; (3) wide, can be used for patients with decompensated liver cirrhosis. The main disadvantages are: (1) the course is not determined, at least 3-5 years; (2) after discontinuation of easy rebound, such as not up to the standard drug, about 80% of patients have the virus replicate; (3) in the process of long-term medication may have the virus mutation, mutation will cause the virus to copy and liver tissue inflammation, need to adjust the treatment plan.

Therefore, the specific choice of what kind of drug treatment, according to the specific circumstances of the patient to consider. For younger age, big three patients, plus interferon therapy; for the older, especially the "small Sanyang", decompensated liver disease patients preferred treatment with nucleoside analogues.

The second hospital of Nanjing Yang Yongfeng

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