新英格兰医学杂志：乙肝病毒感染药物治疗学

lated interferon, which is injected once weekly.



Table 1. Currently Used or Approved Antiviral Therapies for HBeAg-Positive Chronic HBV Infection in Patients Who Have Not Received Treatment.



Table 2. Currently Used or Approved Antiviral Therapies for HBeAg-Negative Chronic HBV Infection in Patients Who Have Not Received Treatment.

As shown in Table 1 and Table 2, treatment for 1 year generally results in the reduction of serum HBV DNA levels by 3.5 to 6.9 log10, a level of serum HBV DNA that is undetectable by polymerase chain reaction in 13 to 95% of patients, normalization of the ALT level in 38 to 79% of patients, histologic improvement in 38 to 74% of patients, and HBeAg seroconversion in 12 to 27% of patients; drugs that suppress HBV DNA more profoundly more often achieve clinical end points (except perhaps HBeAg seroconversion). Among the oral agents, which differ in resistance profile, the nucleotide analogues adefovir and tenofovir are not cross-resistant with lamivudine, telbivudine, or entecavir. Adefovir resistance is negligible during the first year of therapy but approaches 30% by the end of 4 years. Adefovir is very effective in lamivudine-resistant HBV infection.37,38,39,40,53,54,55 Limiting its appeal among the available drugs, adefovir is the least potent, the slowest to suppress HBV DNA levels, the least likely to induce HBeAg seroconversion, and the most likely to result in "primary nonresponse" (i.e., failure to achieve a reduction in the HB

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