Second liver cure is able to bear or endure medicine is approached step by step

Be able to bear or endure medical government time nods reach -- from happen clinical be able to bear or endure medicine (unripe chemical breakthrough) time place reach comes produce virus to learn to break through time to nod, again reach learns respondent dissatisfactory time to nod to virus (inchoate virus learns respondent forecast) , in the future, likelihood happening is able to bear or endure time nods medicine to answer finally reach comes remedial start, prevent namely be able to bear or endure medical government idea. ■ precaution is able to bear or endure medicine -- how to reduce with respect to the consideration when poison of initiative choice disease-resistant is treated be able to bear or endure medical risk, defer be able to bear or endure medical happening. ■ forecast be able to bear or endure medicine -- should have begun to apply a low gene to be able to bear or endure protective screen, high when the disease-resistant poison of medical occurence rate medications, in how be being treated according to the patient inchoate and respondent circumstance is seasonable adjust, the change has remedial strategy, be able to bear or endure with reducing what should medication medical risk. Fight what virus treats strategy for a long time to carry out as chronic hepatitis B, HBV is right nucleotide (acerbity) analogue generation is able to bear or endure medical risk is sure to increase. In the meantime, reach what its apply to increase as medicaments sort, HBV is able to bear or endure the form that medicine mutates also grow in quantity. In fact, current and clinical a gravity that medical frequency is able to bear or endure to go out to already became us to must be faced in fighting HBV to treat a process and important " clinical issue " , and in clinical be able to bear or endure in medical government process, be able to bear or endure the consensus that medical government time nods the new idea of reach to already became virus to learn the home and clinical doctor gradually. Be able to bear or endure at present medical government strategy basically is able to bear or endure for precaution medicine and forecast be able to bear or endure medicine. Current precaution is able to bear or endure medicine basically has strategy of two kinds of cure: (Choice of 1) initiative cure holds concurrently a powerful effect and be able to bear or endure high medical gene protective screen, low be able to bear or endure only drug treats the disease-resistant bane matter of medical occurence rate initiative cure chooses;(2) to be able to bear or endure without across content combines bane of disease-resistant of two kinds of above. Forecast be able to bear or endure medicine treats route chart namely (Roadmap) concept. Precaution is able to bear or endure medical 　 precaution is able to bear or endure medicine begins besides the choice from initiative cure outside, still need to notice: (1) reason applies disease-resistant poison to treat, choose appropriate patient to begin appropriate disease-resistant poison to treat in equal opportunity namely (include to choose appropriate remedy and plan) ;(2) avoids follow in a continuous line of only drug order to treat, because cure of follow in a continuous line of only drug order brings about sequel to treat medicaments curative effect to drop,prevent, be able to bear or endure medical risk rises, the choice that makes poison of disease-resistant of long-term hepatitis B is treated suffers be restricted; prevents generation much medicine to be able to bear or endure at the same time risk;(3) of medicine avoids to choose existence across to be able to bear or endure medical medicaments, lest limit the choice of prospective treatment program. Must prevent from long-term remedy or defer is able to bear or endure medicine produces consideration of this one angle, choice powerful effect, low be able to bear or endure medical medicaments, namely alleged be able to bear or endure high medical gene protective screen and (or) low be able to bear or endure medicaments of medical occurence rate (be like favour replace Ka Wei or replace Nuofuwei) only drug treatment is important precaution to be able to bear or endure formulary case. Clinical and existing data proves, the patient of 90% can achieve the radical cure goal that restrains HBV for a long time to duplicate continuously through case of this one party. Another precaution or defer are able to bear or endure the method of medical happening treats strategy for combination. At present clinical research data shows, associated treatment program can be reduced be able to bear or endure medical happening. But add disease-resistant poisonous curative effect through combining cure to whether can be achieved, reduce again at the same time (defer) be able to bear or endure the double effect of medical happening, heretofore still does not have clear answer and standard method. Those who be worth deliberate is, initiative combine to be able to bear or endure high medicaments of medical gene protective screen has prevent completely to be able to bear or endure without the likelihood medical happening, occurence rate by 1% fall 0? Next, if prove such associated therapy is much better, undertake such clinical research needs every groups > 1000 patients, worth while? Include the combination of this kind of medicaments and interferon, how to evaluate curative effect to increase to be able to bear or endure again medicine decreases happen, the experiment designs special difficulty. Forecast be able to bear or endure medical 　 is latter, show according to replacing the analysis that decides GLOBE research than the husband, cure obtains complete virus 24 weeks to learn respondent patient, its treat 2 years be able to bear or endure medical occurence rate is low. If add the patient with right choice, be able to bear or endure medical occurence rate can fall to 2%~4% , from this, keeffe put forward to treat route chart (Roadmap) concept, will coach according to evaluating disease-resistant poison to treat medium inchoate virus to learn respondent case next clinical cure is decision-making, through adjust and optimizing remedial program, heighten curative effect, decrease be able to bear or endure medical happening. But should put forward, notion of current remedial route chart and plan return far from to one is perfected and optimize plan ideally. Inchoate cure is respondent the relation with long-dated curative effect, not only at present poison of hepatitis B disease-resistant treats consist in in, early had observed in third hepatitis cure. What inchoate and respondent patient treats in third hepatitis cure is long-dated (forecast period of treatment 1 year only) the result is can keep clear of HCV and cure, but fight virus cure to be able to keep clear of HBV without a kind at present, and the long-term remedy that treats a method to be infinite period of treatment. At present so concept of remedial route chart is offerred only and forecast 1~2 year of cure be able to bear or endure medical happening circumstance. Adopt the method that adjust and optimizes, its heighten curative effect for a long time, reduce, defer is able to bear or endure how does medical effect still need evidence of much abide card medicine to try to perfect. Accordingly, the scholar thinks, at present concept of remedial route chart applies at be able to bear or endure medical management is close to the concept that is an attempt or error correction more. We still should notice, make clear according to treating route chart concept and current clinical data, position of different hepatitis B disease, the plan that the adjustment that different disease phase should use optimizes is not identical. In the light of different disease-resistant poison efficiency is mixed different be able to bear or endure the different nucleotide of medical gene protective screen (acerbity) analogue, uses remedial route chart also is abhorrent. The place before be like is narrated, different settling time is nodded (12, 24, 48 weeks of) , different HBV DNA detects floor level value, different adjustment what remedy plan decided to treat process of route chart application to go up is individual change reach optimized concept. The basis is able to bear or endure the concept of reach of medical government time, the administration that treats route chart bears medical concept already will active be able to bear or endure the time that medicine intervenes nods reach one stride, this to low be able to bear or endure medical gene protective screen kind medicaments has his real value. Through using route chart, we can choose the patient that suits this kind of medicaments partly at least, be reduced thereby or defer is able to bear or endure medical happening. But be able to bear or endure to tall gene of medicaments of medical protective screen be able to bear or endure medical management, be afraid the concept that uses route chart very hard and method will try to come true. Inchoate " come to help " remedial 　 already happened be able to bear or endure of medical patient " come to help " remedial time is nodded also already reach learns a breakthrough to only virus, is not to already happened clinical be able to bear or endure the time of biochemical breakthrough selects drug. Specific " come to help " remedial program sees a table 1. ■ brief summary 　 from clinical be able to bear or endure the basic strategy of medical management will tell, the start that chooses management and interpose time reach to be treated to disease-resistant poison, when we start disease-resistant poison to treat, considering decrease, defer is able to bear or endure medical happening, choose appropriate remedy and remedial program to undertake medicine prevents is able to bear or endure effectively, this just is clinical probably the most effective, handy, feasible be able to bear or endure medical government program. Watch 1 HBV is able to bear or endure the processing strategy 　 that medicine mutates is able to bear or endure medical type " come to help " LAM of 　 of remedial strategy 　 is able to bear or endure medicine is added change the ETV(1.0 Mg/d that uses 2 times dose with ADV 　 , but be able to bear or endure medical mutation occurence rate relatively the person that treat at the beginning of LAM is tall) 　 is added had be notted approve by SFDA with TFV() 　 is changed with Truvada(TFV+FTC, had be notted approve by SFDA) 　 changes use interferon α or get together glycol changes interferon α (still require abide card basis) 　 　 ADV is able to bear or endure medical 　 adds use LAM or the person that LdT or ETV(cross LAM to using is good) 　 changes use Truvada or TFV(have not by SFDA: Plum apricot)