B 型肝炎治療ガイドライン （第2版） - jsh.or.jp

1 B 2014 6 ** * HGF * ** Corresponding author: 173-8605 2 11 1 Tel 03(3964)1211 Fax 03(3964)6627 Email 2013 4 1 2013 5 ALT U/l 3 Peg- IFN 5 HBs p39 p49 17 3TC 2013 9 HBV DNA PCR 2014 6 2 ( )

2 1 off treatment - off treatment IFN 1-5-2 4- 6-1 off treatment 8 HBV DNA log copies/ml 14 15 3 Drug-free sequential 5-1-4 8 B 18 B 19 HBV HIV 1 1-1 B 1 1-2 HBV 1 1-3 3 1-4 5 1-5 10 1-5-1 11 1-5-2 12 1-5-3 13 1-5-4 13 1-5-5 14 1-5-6 15 HBV 16 2-1 HBV 16 2-2 HBV DNA 17 2-3 HBs 19 2-4 HB 23 IFN 25 3-1 IFN 25 3-2 IFN IFN 25 3-2-1 HBe 25 3-2-2 HBe 26 3-3 Peg-IFN -2a 26 3-3-1 HBe 27 3-3-2 HBe 28 3-4 B IFN 29 3-5 30 3-6 30 3-6-1 HBV 30 3-6-2 HBs 32 3-6-3 33 3-6-4 IL28B 33 3-7 34 36 4-1 36 4-2 37 4-3 38 4-4 40 4-4-1

3 40 4-4-2 3 41 4-4-3 43 4-5 44 4-5-1 44 4-5-2 45 4-5-3 46 4-5-4 46 4-6 47 4-6-1 47 4-6-2 sequential 49 4-6-3 Sequential 50 52 5-1 52 5-1-1 52 5-1-2 52 5-1-3 53 5-1-4 54 5-2 HBe 57 5-2-1 57 5-2-2 58 5-3 HBe 59 5-3-1 59 5-3-2 60 5-4 61 5-4-1 62 5-4-2 62 5-5 63 5-5-1 IFN 63 5-5-2 64 66 6-1 66 6-2 67 6-2-1 67 6-2-2 68 6-2-3 68 6-2-4 IFN 69 6-3 HBV 70 6-3-1 75 6-3-2 76 6-3-3 76 6-3-4 78 6-3-5 78 6-3-6 78 6-3-7 78 6-3-8 79 6-3-9 79 6-3-10 80 6-4 HIV 80 6-4-1 80 6-4-2 81 6-4-3 81 1-1 B B hepatitis B virus.

4 HBV 4 1) HBV 1% HBV 9 9 HBe HBe HBe 1 2 2-4) HBV 1964 Blumberg HBs Prince HBV HBV HBV Dane 1970 HBe 1972 1979 HBV (HBV DNA) 1972 HBs 1986 HBV HBs B A HBV 5) 1-2 HBV HBV HBV T T T HBV HBV DNA 4 immune tolerance phase HBV HBV HBe HBV DNA ALT 20 1 immune clearance phase HBV HBe HBe HBe HBV DNA HBe HBe low replicative phase (inactive phase)

5 HBe HBV DNA 4 log copies/ml 10 20% HBe HBe HBV HBe 4 20% HBe HBe remission phase HBe HBs HBs HBV HBs 1% 1 HBV 2 HBV HBe HBe 5 8% HBe HBV DNA ALT HBe HBV HBV HBV A 5) 1-3 HBV HBV QOL HBV 3 HBV HBV HBV HBV QOL surrogate marker HBs HBV HBs HBs ALT 30 U/l HBe HBe HBe HBe HBe HBe HBV DNA 3 HBV DNA HBV DNA on- treatment

6 PCR HBV DNA off-treatment HBV DNA log copies/ml interferon; IFN HBe 3 HBs HBV DNA 24 48 24 48 HBV DNA log copies/ml HBs ALT *1 *1 HBe *2 *2 HBV DNA *3 on-treatment off-treatment IFN / 4 4 log copies/ml - *5 *1. 30 U/l *2. HBe HBe HBe HBe *3. PCR PCR *4. 24 48 *5. Recommendation HBV QOL surrogate marker HBs HBs HBs ALT HBe HBe HBV DNA 3 on-treatment HBV DNA off-treatment 4 HBV DNA log copies/ml IFN HBe HBs HBV DNA 24 48 24 48 HBV DNA log copies/ml 1-4 HBV IFN 1987

7 28 ; HBe 2002 6 ; HBe 2000 2004 2006 2011 2014 IFN IFN 1987 28 2002 6 2011 B (pegylated interferon: Peg-IFN) IFN HBV DNA Peg -IFN drug free HBs Peg -IFN HBe 20 30% HBe 20 40% 1 Peg-IFN 5 human immunodeficiency virus HIV HBV 2000 2006 3 B 2014 HBV DNA HBV DNA ALT

8 IFN HBs Peg -IFN HBe HBs Peg- IFN ALT HBV DNA Peg -IFN B B Peg-IFN Recommendation Peg-IFN 2b B) B B Peg-IFN B) 6 Peg-IFN Peg-IFN 24 48 *1 *2 *3 *4 HBe 20 30% HBe 20 40% *1 3 1% 6 *2 EASL 6) APASL 7) B Peg-IFN *3 FDA C B *4 7 Peg-IFN HBe Peg-IFN HBV DNA 14% 8)

9 67 75% 9, 10) 57 66%11, 12) 13% 13-15) 93 94% 10, 16) 93% 17) HBe 24 36% 8, 18, 19) 16 21% 9, 10) 9 21%11, 12) 37 60% 13-15) 34 44% 20-22) 26% 17) ALT 37 52% 8, 18, 19) 68 81% 9, 10) 68%11) 47% 13-15) 87 95% 10, 23) 74%17) HBs 8, 18, 19) 9) ) 11% 13) 16, 20) 24) 8%17) * 30% 13) Peg-IFN (Peg-IFN -2a 8, 14, 18, 19) Peg-IFN -2b 13, 15) ) 24 6, 16, 17) 3 11) * 26 HBe 37% 21% 1 9) 2 23, 24) 3 20-22) 4 10) 5 16) 1 11, 12) 3 17) 8 Peg-IFN HBe Peg-IFN HBV DNA 19 20% 25) 90 99% 10, 26) 71% 95%11, 12) 18 21% 27) 28) 100% 10) 99%17) HBV DNA (<20,000 copies /ml) 43 44% 25) (<10,000 copies /ml) 25 28% 27) ALT 59 60% 25) 78 85% 10, 26) 76%11)