AIM: To evaluate the impact of combination therapy with Lamivudine and Adefovir for treatment of chronic hepatitis B in Lamivudine-resistant patients. METHODS: Among the 110 adult chronic hepatitis B Iranian patients ...AIM: To evaluate the impact of combination therapy with Lamivudine and Adefovir for treatment of chronic hepatitis B in Lamivudine-resistant patients. METHODS: Among the 110 adult chronic hepatitis B Iranian patients whom were treated with Lamivudine, for 36 months, nineteen patients (17%) with no any biochemical and viral responses to Lamivudine alone, were selected and enrolled in the study. Due to resistancy, Adefovir was added to Lamivudine, and continued for 30 months. We measured HBV_DNA viral load and serum AST, ALT in 0, 12, 24, 30 and 0, 6, 12, 18, 24, 30 months, respectively. RESULTS: Between biochemical and viral characteristics, Repeated Measure analysis identified just biochemical markers— Aspartate Aminotransferase level (AST) (P = 0.002) and Alanine Aminotransferase level (ALT) (P = 0.007) —as predictors of response to treatment, while, viral marker—HBV DNA load—was not statistically significant (P = 0.128). CONCLUSIONS: Treatment for a long time, such as 21.5 ± 8.8 months, with Lami- vudine and Adefovir, can cause liver enzymes including AST and ALT, decreasing and being normal. But, this finding is not indicative, for HBV-DNA viral load.展开更多
The selection of antiviral drugs for chronic hepatitis B(CHB) treatment in pregnancy is very difficult since none of the drugs have been approved for use in pregnancy.Transmission from mother to newborn remains the mo...The selection of antiviral drugs for chronic hepatitis B(CHB) treatment in pregnancy is very difficult since none of the drugs have been approved for use in pregnancy.Transmission from mother to newborn remains the most frequent route of infection in mothers with high viral load and positive hepatitis B e antigen status,even with the use of appropriate prophylaxis with hepatitis B virus(HBV) immunoglobulin and HBV vaccination.We read from the article written by Yi et al that lamivudine treatment in early pregnancy was safe and effective.However,we could not understand why adefovir dipivoxil(ADV) was used in three pregnancy cases,since ADV has been classified as pregnancy category C.In pregnancy,telbivudine or tenofovir should be selected when the treatment of CHB is necessary,since these drugs have been classified as Food and Drug Administration pregnancy risk category B.展开更多
目的评价拉米夫定(LAM)联合阿德福韦酯(ADV)与恩替卡韦(ETV)单药对慢性乙型肝炎初治患者的疗效。方法计算机检索Cochrane图书馆、MEDLINE、Web of Science、CNKI全文数据库、万方中文期刊全文数据库、维普数据库,并追查了所有纳入文献...目的评价拉米夫定(LAM)联合阿德福韦酯(ADV)与恩替卡韦(ETV)单药对慢性乙型肝炎初治患者的疗效。方法计算机检索Cochrane图书馆、MEDLINE、Web of Science、CNKI全文数据库、万方中文期刊全文数据库、维普数据库,并追查了所有纳入文献的参考文献。检索年限均从建库到2012年3月6日。纳入LAM联合ADV与ETV单药对慢性乙型肝炎初治患者疗效比较。用Cochrane协作网专用软件Rev Man 5.1进行统计分析。结果共有4项符合纳入标准的研究被纳入。Meta分析显示,在ALT复常率方面,12、24周时ETV单药组略高于联合组[OR=0.52,95%CI(0.28,0.97),Z=2.04,P=0.04]、[OR=0.45,95%CI(0.22,0.95),Z=2.11,P=0.04],但36、48周后两组无明显差异[OR=0.96,95%CI(0.24,3.94),Z=0.05,P=0.96]、[OR=0.66,95%CI(0.28,1.59),Z=0.93,P=0.35]。HBV DNA阴转率方面12、24、36、48周、18、24、30个月两组间均无明显差异(P=0.22、P=0.30、P=0.86、P=0.31、P=0.93、P=0.84、P=0.83)。48周的HBeAg阴转率两组无差异[OR=0.93,95%CI(0.29,2.95),Z=0.13,P=0.90]。结论 LAM联合ADV对慢性乙型肝炎初治患者其抗病毒疗效与ETV相似,但其长期疗效和安全性仍然有待研究。展开更多
目的探讨拉米夫定耐药后e抗原(HBeAg)阳性慢乙肝(CHB)患者血清表面抗原(HBsAg)滴度的动态变化对拉米夫定联用阿德福韦酯挽救治疗疗效的预测价值。方法收集51例拉米夫定耐药的HBeAg阳性CHB患者联用阿德福韦酯挽救治疗前后的血清,检测并...目的探讨拉米夫定耐药后e抗原(HBeAg)阳性慢乙肝(CHB)患者血清表面抗原(HBsAg)滴度的动态变化对拉米夫定联用阿德福韦酯挽救治疗疗效的预测价值。方法收集51例拉米夫定耐药的HBeAg阳性CHB患者联用阿德福韦酯挽救治疗前后的血清,检测并分析不同应答组各时间点丙氨酸氨基转移酶(ALT)、HBsAg滴度、乙肝病毒(HBV)DNA载量差异。结果从基线到治疗12周开始,发生病毒学应答VR(+)组患者HBsAg滴度较无应答VR(-)组患者下降更快(P=0.041)。治疗12周时HBsAg滴度预测病毒学应答的ROC曲线下面积最大(AUC=0.821,P=0.006)。ROC曲线提示HBsAg为3.50 lg IU/ml时对应的Youden指数(0.612)最大。结论拉米夫定耐药后加用阿德福韦酯挽救治疗12周时HBsAg≤3.50 lg IU/ml可作为预测治疗72周发生病毒学应答的指标。展开更多
文摘AIM: To evaluate the impact of combination therapy with Lamivudine and Adefovir for treatment of chronic hepatitis B in Lamivudine-resistant patients. METHODS: Among the 110 adult chronic hepatitis B Iranian patients whom were treated with Lamivudine, for 36 months, nineteen patients (17%) with no any biochemical and viral responses to Lamivudine alone, were selected and enrolled in the study. Due to resistancy, Adefovir was added to Lamivudine, and continued for 30 months. We measured HBV_DNA viral load and serum AST, ALT in 0, 12, 24, 30 and 0, 6, 12, 18, 24, 30 months, respectively. RESULTS: Between biochemical and viral characteristics, Repeated Measure analysis identified just biochemical markers— Aspartate Aminotransferase level (AST) (P = 0.002) and Alanine Aminotransferase level (ALT) (P = 0.007) —as predictors of response to treatment, while, viral marker—HBV DNA load—was not statistically significant (P = 0.128). CONCLUSIONS: Treatment for a long time, such as 21.5 ± 8.8 months, with Lami- vudine and Adefovir, can cause liver enzymes including AST and ALT, decreasing and being normal. But, this finding is not indicative, for HBV-DNA viral load.
文摘The selection of antiviral drugs for chronic hepatitis B(CHB) treatment in pregnancy is very difficult since none of the drugs have been approved for use in pregnancy.Transmission from mother to newborn remains the most frequent route of infection in mothers with high viral load and positive hepatitis B e antigen status,even with the use of appropriate prophylaxis with hepatitis B virus(HBV) immunoglobulin and HBV vaccination.We read from the article written by Yi et al that lamivudine treatment in early pregnancy was safe and effective.However,we could not understand why adefovir dipivoxil(ADV) was used in three pregnancy cases,since ADV has been classified as pregnancy category C.In pregnancy,telbivudine or tenofovir should be selected when the treatment of CHB is necessary,since these drugs have been classified as Food and Drug Administration pregnancy risk category B.
文摘目的评价拉米夫定(LAM)联合阿德福韦酯(ADV)与恩替卡韦(ETV)单药对慢性乙型肝炎初治患者的疗效。方法计算机检索Cochrane图书馆、MEDLINE、Web of Science、CNKI全文数据库、万方中文期刊全文数据库、维普数据库,并追查了所有纳入文献的参考文献。检索年限均从建库到2012年3月6日。纳入LAM联合ADV与ETV单药对慢性乙型肝炎初治患者疗效比较。用Cochrane协作网专用软件Rev Man 5.1进行统计分析。结果共有4项符合纳入标准的研究被纳入。Meta分析显示,在ALT复常率方面,12、24周时ETV单药组略高于联合组[OR=0.52,95%CI(0.28,0.97),Z=2.04,P=0.04]、[OR=0.45,95%CI(0.22,0.95),Z=2.11,P=0.04],但36、48周后两组无明显差异[OR=0.96,95%CI(0.24,3.94),Z=0.05,P=0.96]、[OR=0.66,95%CI(0.28,1.59),Z=0.93,P=0.35]。HBV DNA阴转率方面12、24、36、48周、18、24、30个月两组间均无明显差异(P=0.22、P=0.30、P=0.86、P=0.31、P=0.93、P=0.84、P=0.83)。48周的HBeAg阴转率两组无差异[OR=0.93,95%CI(0.29,2.95),Z=0.13,P=0.90]。结论 LAM联合ADV对慢性乙型肝炎初治患者其抗病毒疗效与ETV相似,但其长期疗效和安全性仍然有待研究。
文摘目的探讨拉米夫定耐药后e抗原(HBeAg)阳性慢乙肝(CHB)患者血清表面抗原(HBsAg)滴度的动态变化对拉米夫定联用阿德福韦酯挽救治疗疗效的预测价值。方法收集51例拉米夫定耐药的HBeAg阳性CHB患者联用阿德福韦酯挽救治疗前后的血清,检测并分析不同应答组各时间点丙氨酸氨基转移酶(ALT)、HBsAg滴度、乙肝病毒(HBV)DNA载量差异。结果从基线到治疗12周开始,发生病毒学应答VR(+)组患者HBsAg滴度较无应答VR(-)组患者下降更快(P=0.041)。治疗12周时HBsAg滴度预测病毒学应答的ROC曲线下面积最大(AUC=0.821,P=0.006)。ROC曲线提示HBsAg为3.50 lg IU/ml时对应的Youden指数(0.612)最大。结论拉米夫定耐药后加用阿德福韦酯挽救治疗12周时HBsAg≤3.50 lg IU/ml可作为预测治疗72周发生病毒学应答的指标。
