Viral response at 6 months is associated with treatment outcome of adefovir add-on therapy for lamivudine-resistance
阿德福韦治疗拉米夫定耐药的最终结果和治疗后第6个月HBV的DNA载量相关
肝胆速递：阿德福韦治疗拉米夫定耐药的最终结果和初始及治疗后第6个月的HBV的DNA载量相关
Journal of Gastroenterology and Hepatology Vol 27 Issue 9
Viral response at 6 months is associated with treatment outcome of adefovir add-on therapy for lamivudine-resistance
Yu Jin Kim,
Seung Woon Paik*,
Dong Hyun Sinn,
Geum-Youn Gwak,
Moon Seok Choi,
Joon Hyeok Lee,
Kwang Cheol Koh,
Byung Chul Yoo
Article first published online: 21 AUG 2012
DOI: 10.1111/j.1440-1746.2011.07050.x
Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
*Professor Seung Woon Paik, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. E-mail: [email protected]
Abstract
Background and Aim: Adefovir add-on therapy is recommended for patients infected with lamivudine-resistant hepatitis B virus (HBV). We aimed to describe the long-term treatment outcome and predictors for good response of adefovir add-on therapy.
Methods: A total of 559 chronic hepatitis B (CHB) patients who had been treated for at least 12 months with adefovir add-on therapy due to resistance to lamivudine were retrospectively included. Complete virologic response (CVR) was defined as serum HBV DNA < 9 IU/mL. Viral responses at 6 months were classified as PCR negativity, partial virologic response (PVR, HBV DNA < 2000 IU/mL), or inadequate virologic response (IVR, HBV DNA ≥ 2000 IU/mL).
Results: The median duration of follow-up was 31.5 months (range, 12–56). The cumulative probabilities of CVR during adefovir add-on therapy were 58%, 70%, 78%, and 80% at 12, 24, 36, and 43 months, respectively. The cumulative rates of resistance to adefovir were 0.4%, 0.8%, and 3.1% at 12, 24, and 36 months, respectively. The only baseline factor associated with CVR (hazard ratio 0.83, 95% confidence interval 0.62–0.91, P ≤ 0.001) and resistance to adefovir (hazard ratio 1.925, 95% confidence interval 1.13–3.30, P = 0.017) was serum HBV DNA level. Comparison of the cumulative rates of CVR and resistance to adefovir according to viral response at 6 months showed significant differences among the three groups (P < 0.0001 and P = 0.0005, respectively).
Conclusions: Pre-treatment HBV DNA level and viral response at 6 months is associated with treatment outcome for adefovir-add on therapy in lamivudine resistance.
方法：将559例慢性乙型肝炎（CHB）患者经治疗后已至少12个月，阿德福韦酯治疗，由于对拉米夫定的耐药进行回顾性。完整的病毒学应答（CVR）被定义为血清HBV DNA <9 IU /毫升。在6个月被列为PCR阴性，部分病毒学应答（PVR，HBV DNA <2000 IU /毫升），或不足病毒学应答（IVR，HBV DNA≥2000 IU /毫升）病毒反应。