Deepak Amarapurkar

 

　　在世界范围内，HBV感染与肝细胞肝癌（HCC）的发生、发展密切相关。许多研究表明，HBV DNA水平是慢性乙型肝炎患者罹患HCC的最重要危险因素之一。核苷（酸）类似物（NA）和干扰素（IFN）是目前慢性乙型肝炎的主要治疗药物。在22日上午，来自印度孟买医院和医疗研究中心的Deepak amarapurkar教授发表了题为“从预防HCC角度看核苷或干扰素治疗乙型肝炎”的演讲，与亚太地区的肝病学者讨论抗病毒治疗与肝癌预防的关系。

 

　　目前，有7种药物被批准用于抗HBV治疗：两种干扰素（干扰素，长效干扰素）和五种NA（包括拉米夫定、替比夫定、恩替卡韦、阿德福韦酯和替诺福韦酯）。其中，干扰素治疗的优势在于，与NA相比，可在有限的治疗时间内，具有较高的HBsAg清除率，尤其对不同基因型的HBV感染以及低病毒载量患者有效。干扰素治疗的主要缺点是具有明显的不良反应和需要注射用药，且不能用于失代偿期患者。与干扰素治疗相比，NA可以口服给予、无明显不良反应、可用于失代偿期患者。然而，NA对于HBsAg清除率很低，大多数患者需要长期治疗，而且随着病毒抗药性的发生，疗效显著降低。

 

　　系统回顾和分析显示，经干扰素或NA抗病毒治疗，患者发生肝细胞癌的风险约降低50%~60%。然而，慢性乙型肝炎患者发生HCC的危险性不能完全消除。因此，需要对患者进行随访，进行肝细胞癌的监测。

 

Nucleos(t)ide or Interferon to Prevent HBV-related HCC?

 

　　Hepatitis Bvirus(HBV) infection is associated with the development of hepatocellular carcinoma (HCC) worldwide, and many studies have shown that the HBV DNA level is one of the most significant risk factors for the development of HCC in patients with chronic HBV infection. Nucleos(t)ide analogues (NAs) and interferons (IFN), the current standard of care for chronic HBV infection, could decrease the risk of HCC. This morning, Professor Deepak Amarapurkar from Bombay Hospital and Medical Research Centre, India will give a lecture entitled “Nucleotide or Interferon for the Treatment of HBV (Prevention of HCC)”.

 

　　Currently there are 7 approved agents: two formulations of IFN (IFN, PEG-IFN) and five NAs including lamivudine, telbivudine, entecavir, adefovir and tenofovir. Advantages of IFN include a finite treatment duration associated with a higher percentage of HBsAg clearance compared with NA

 

　　therapy, and it is especially effective in genotype A or B HBV infected patients with low viral load.

 

　　The main disadvantages of IFN treatment are significant side effects and administration by injection, and it cannot be used in decompensated patients. Compared with IFN treatment, NAs can be administered

 

　　orally without significant side effects and can be used in decompensated patients. However, the rate of HBsAg clearance with NAs is very low, so long-term treatment is necessary in most patients and the efficacy is significantly reduced with development of viral resistance.

 

　　Systemic reviews and metaanalysis have shown approximately 50-60% risk reduction for HCC with IFN or NA antiviral therapy. However, the risk of HCC couldn’t be completely eliminated in patients with chronic HBV infection. Therefore, the patients need to be followed up for HCC surveillance lifelong.

 

General Session 1：HBV Treatment in Various Countries 1 - "Nucleotide or IFN for the Treatment of HBV (Prevention of HCC)"

09:00 - 09:20

Room 1A