多重耐药HBV感染特点及挽救治疗策略

多重耐药HBV感染的治疗是临床面临的一个难题。多重耐药的发生主要与病毒因素、宿主因素和药物因素等相关。严格评估抗病毒治疗指征,初治选择高耐药基因屏障的抗病毒药物,避免以低耐药基因屏障药物起始的单药序贯治疗等措施能够降低多重耐药HBV株产生的风险。对于已发生耐药与多重耐药HBV感染的患者,应尽早开始挽救性治疗。有多项研究提示恩替卡韦与替诺福韦酯联合是针对难治性多重耐药HBV感染的更加有效、安全的挽救性治疗方案。研究开发多靶点作用的新型抗病毒药物是治疗多重耐药HBV感染的新途径。

Characteristics and rescue therapy strategies of multidrug-resistant HBV infection

Multidrug-resistant HBV infection is a great challenge to the antiviral therapy in clinic. The development of multidrug-resistant HBV is associated with virus factors, host factors and drug factors. Strict evaluation on the treatment indications, choosing nucleos(t)ide analogues with a higher drug-resistant genetic barrier in initial treatment regimen and avoiding sequential mono- therapy starting with a lower drug-resistant genetic barrier drug can reduce the risk of developing multidrug-resistant HBV strain. Rescue therapy should be taken as early as possible for patients who have already developed the drug-resistant and multidrug-resistant virus infection. Recently, increasing evidence suggest that combination of entecavir and tenofovir is a more efficacious and safer rescue therapy for difficult-to-treat multidrug-resistant HBV infection. The development of new antiviral agents with multiple-targets may provide a new way for the treatment of multidrug-resistant HBV infection.