目的研究HBeAg阴性乙肝病毒(hepatitis B virus,HBV)DNA阳性慢性乙肝病毒感染者达到治疗时间的预测指标。方法将入组的108例患者,根据肝脏病理结果分为治疗组和随访组,将年龄、性别、感染家族史、HBsAg定量水平、HBV DNA载量纳入单因素...目的研究HBeAg阴性乙肝病毒(hepatitis B virus,HBV)DNA阳性慢性乙肝病毒感染者达到治疗时间的预测指标。方法将入组的108例患者,根据肝脏病理结果分为治疗组和随访组,将年龄、性别、感染家族史、HBsAg定量水平、HBV DNA载量纳入单因素分析,有统计学意义的变量进行Logistic多变量回归分析,有影响的独立危险因素应用受试者操作特征曲线定义截断值。结果108例HBeAg阴性HBV DNA阳性慢性乙肝病毒感染者达到治疗标准的有29例,占比26.7%。年龄、感染家族史是需要治疗的独立危险因素。年龄的截断值为35.5岁。结论HBeAg阴性HBV DNA阳性慢性乙肝病毒感染者中也有需要治疗的,年龄大、有感染家族史是需要治疗的独立预测危险因素,年龄大于35.5岁时,需要抗病毒治疗,而HBsAg定量水平、HBV DNA载量不是独立预测危险因素。展开更多
Background/Aims: To determine the response to pegylated interferon-α treatment of HBeAg-positive hepatitis B patients with proven lamivudine resistance. Methods: Sixteen HBeAg-positive HBV patients with YMDD mutation...Background/Aims: To determine the response to pegylated interferon-α treatment of HBeAg-positive hepatitis B patients with proven lamivudine resistance. Methods: Sixteen HBeAg-positive HBV patients with YMDD mutations were treated with pegylated interferon. Median treatment duration was 52 weeks (range 20- 53), with a 26- week follow-up. Results: Two of 16 (12.5% ) patients seroconverted to HBeAg negative and achieved sustained virological (HBV-DNA levels below 10log 5 copies/ml) together with biochemical (normalization of serum ALT levels) responses. Compared with the strong signal in all other patients, only these two patients had a faint signal in the lamivudine resistance assay. For all patients, the median viral load decreased from 10log 9.4 to 7.9 copies/ml (P=0.001) during treatment but rebounded to a median of 10log 8.7 copies/ml after treatment cessation. Similarly, elevated median ALT levels at baseline decreased with treatment but rebounded after the end of treatment. Conclusions: In the largest cohort study to date, pegylated interferon-α therapy showed marginal efficacy in the presence of lamivudine resistance but such therapy may be beneficial in patients with only small amounts of mutant virus. In our opinion, an analysis of the patient subgroup harbouring an YMDD-mutation should be included in all future studies of pegylated interferon-α in chronic hepatitis B.展开更多
Tenofovir disoproxil fumarate(TDF)has shown in vitro activity against both HIV and hepatitis B virus(HBV).We retrospectively evaluated the efficacy of TDF(300 mg/d),administered as a part of anti-retroviral therapy,in...Tenofovir disoproxil fumarate(TDF)has shown in vitro activity against both HIV and hepatitis B virus(HBV).We retrospectively evaluated the efficacy of TDF(300 mg/d),administered as a part of anti-retroviral therapy,in a large cohort of HIV/HBVcoinfected patients.Sixty-five HIV/HBV-coinfected patients who received TDF for at least 6 months with serum HBV DNA levels above 2.3 log10 copies/mL at TDF initiation and who had stored serum samples before and during TDF therapy were included.Serum HBV DNA was measured on stored samples.The median follow-up period was 12(Q1-Q3:8-17)months.Serum hepatitis B e antigen(HBeAg)was positive in 54 patients(83.1%).Fifty-two patients(80.0%)were receiving lamivudine(LAM)(150 mg twice a day),and 68.8%had documented LAM resistance at baseline.Among HBeAg positive patients,the median reduction from baseline(8.17;Q1-Q3 = 7.30-8.30 log10copies/mL)of serum HBV DNA was 4.56 log10 copies/mL(Q1-Q3 = 3.33-5.55)(P <.0001).In HBeAg-negative patients,serum HBV DNA decline from baseline(4.83;Q1-Q3 = 2.69-6.40 log10 copies/mL)was 2.53 log10 copies/mL(Q1-Q3 = 0.39-4.10).At the end of the study,HBV DNA became undetectable in 29.6%and 81.6%of the HBeAg positive and HBeAg-negative patients,respectively.Serum HBeAg became negative in 4 patients,2 of whom acquired serum hepatitis B e antibody.In conclusion,this retrospective analysis demonstrates the efficacy of TDF against wild-type,presumed precore mutants and LAM-resistant HBV when used as a part of anti-retroviral therapy in HIV-coinfected patients.展开更多
文摘Background/Aims: To determine the response to pegylated interferon-α treatment of HBeAg-positive hepatitis B patients with proven lamivudine resistance. Methods: Sixteen HBeAg-positive HBV patients with YMDD mutations were treated with pegylated interferon. Median treatment duration was 52 weeks (range 20- 53), with a 26- week follow-up. Results: Two of 16 (12.5% ) patients seroconverted to HBeAg negative and achieved sustained virological (HBV-DNA levels below 10log 5 copies/ml) together with biochemical (normalization of serum ALT levels) responses. Compared with the strong signal in all other patients, only these two patients had a faint signal in the lamivudine resistance assay. For all patients, the median viral load decreased from 10log 9.4 to 7.9 copies/ml (P=0.001) during treatment but rebounded to a median of 10log 8.7 copies/ml after treatment cessation. Similarly, elevated median ALT levels at baseline decreased with treatment but rebounded after the end of treatment. Conclusions: In the largest cohort study to date, pegylated interferon-α therapy showed marginal efficacy in the presence of lamivudine resistance but such therapy may be beneficial in patients with only small amounts of mutant virus. In our opinion, an analysis of the patient subgroup harbouring an YMDD-mutation should be included in all future studies of pegylated interferon-α in chronic hepatitis B.
文摘Tenofovir disoproxil fumarate(TDF)has shown in vitro activity against both HIV and hepatitis B virus(HBV).We retrospectively evaluated the efficacy of TDF(300 mg/d),administered as a part of anti-retroviral therapy,in a large cohort of HIV/HBVcoinfected patients.Sixty-five HIV/HBV-coinfected patients who received TDF for at least 6 months with serum HBV DNA levels above 2.3 log10 copies/mL at TDF initiation and who had stored serum samples before and during TDF therapy were included.Serum HBV DNA was measured on stored samples.The median follow-up period was 12(Q1-Q3:8-17)months.Serum hepatitis B e antigen(HBeAg)was positive in 54 patients(83.1%).Fifty-two patients(80.0%)were receiving lamivudine(LAM)(150 mg twice a day),and 68.8%had documented LAM resistance at baseline.Among HBeAg positive patients,the median reduction from baseline(8.17;Q1-Q3 = 7.30-8.30 log10copies/mL)of serum HBV DNA was 4.56 log10 copies/mL(Q1-Q3 = 3.33-5.55)(P <.0001).In HBeAg-negative patients,serum HBV DNA decline from baseline(4.83;Q1-Q3 = 2.69-6.40 log10 copies/mL)was 2.53 log10 copies/mL(Q1-Q3 = 0.39-4.10).At the end of the study,HBV DNA became undetectable in 29.6%and 81.6%of the HBeAg positive and HBeAg-negative patients,respectively.Serum HBeAg became negative in 4 patients,2 of whom acquired serum hepatitis B e antibody.In conclusion,this retrospective analysis demonstrates the efficacy of TDF against wild-type,presumed precore mutants and LAM-resistant HBV when used as a part of anti-retroviral therapy in HIV-coinfected patients.
