编者按：2017年4月19日，第52届欧洲肝脏研究学会（EASL）年会在荷兰阿姆斯特丹盛大召开。在19日上午召开的EASL/病毒性肝炎工作组（VHG）联合研讨会上，来自西班牙巴塞罗那Vall d'Hebron大学 的Maria Buti教授做了关于乙型肝炎治疗进展及展望的专题报告。会后，本刊特邀请Buti教授针对乙型肝炎治疗的最新进展进行了专访。
《国际肝病》：慢性HBV感染如此难以治愈的主要原因是什么？
Buti教授：慢性乙型肝炎（CHB）难以治愈的主要原因是感染肝细胞核中的病毒持续存留。如果没有强效的免疫应答，HBV的彻底清除难以实现。我们所面临的现实是，大多数CHB患者的免疫应答都非常微弱。
Prof. Buti: The main reason that hepatitis B is so difficult to cure is that the virus persists in the nucleus of infected hepatocytes, so it is very difficult to clear the virus without a strong immune response. The majority of infected patients in fact have a very weak immune response.
《国际肝病》：目前，我们在慢乙肝疾病的认识以及治疗上有哪些最新的研究进展？
Buti教授：截至目前，CHB治疗的最大临床研究进展是替诺福韦艾拉酚胺富马酸（TAF）的应用。TAF是一种新型核苷类逆转录酶抑制剂，是替诺福韦酯（TDF）的升级版。包括在年轻的妇女当中，TAF较TDF具有更好的安全性， 具有更广的安全使用人群。对于对拉米夫定耐药的经治患者亦有疗效。
此外，我们也可以看到有很多靶向HBV复制周期不同位点的新药正在进行I 期、 II期的临床试验，目前取得了非常初步的结果。未来CHB的治疗策略，可能是多种治疗手段的联合，包括衣壳抑制剂、RNA干扰、HBsAg抑制剂以及核苷类似物。这也是未来几年我们探索的主要方向。
Prof. Buti: Up until now, the main advance has been TAF. It is a new tenofovir prodrug. I think this drug is very important in China. We can use this drug very safely, including in young women. It has a better safety profile than tenofovir and it can be used in patients previously exposed to lamivudine who have resistance to that drug. So in clinical practice, the main advance has been TAF.
We now have many drugs in development in phase I and phase II studies. They are looking at different targets in the hepatitis B virus replication cycle. The results are very preliminary but we probably will need combinations of these drugs - capsid inhibitors, RNA interference, HBsAg inhibitors and nucleoside analogs. So I think investigations over the next few years will be following those lines.
《国际肝病》：随着近年来在乙肝研究方面的可观进展，我们距离实现治愈慢性乙肝病毒感染的目标更近了吗？
Buti教授：我们离慢乙肝治愈的目标还不是很近，至少仍需要5~7年的时间。慢乙肝的治疗相对于丙型肝炎的治疗更为复杂，目前取得的成果都是非常初步的，慢乙肝的治疗不会像丙型肝炎治疗一样有突然的爆发，但是相信我们终将战胜它。
Prof. Buti: No, not very close. We need at least 5-7 years to know. Everything is in preclinical development. It is more difficult in hepatitis B than it is for hepatitis C. I am not predicting a sudden revolution in hepatitis B treatment. I think in the end, however, we will achieve that goal.