StephenW 发表于 2013-1-6 22:29
回复 yg88 的帖子
"接下来第一项病毒量在200左右时准备干扰素+恩替卡韦治疗了。。祝我好运"
StephenW 发表于 2013-1-6 22:29
回复 yg88 的帖子
"接下来第一项病毒量在200左右时准备干扰素+恩替卡韦治疗了。。祝我好运"
苏小三 发表于 2013-1-6 22:19
祝你好运，以前有人试过，有转的有没转的，没转的多
yg88 发表于 2013-1-6 22:34
谢谢StephenW的回复。目前这个方案应该是可行的，必竟有8人表面抗原低于检测值了。第二项也有抗体了。您 ...
StephenW 发表于 2013-1-6 23:16
回复 yg88 的帖子
另外我怎么看到有人拿到金牌后还是又反弹了，拿到金牌后也要反弹？
| TITLE: Is HBsAg Seroclearance Following Nucleoside Analogue Therapy Durable in Patients with Chronic Hepatitis B? |
| AUTHORS (FIRST NAME, LAST NAME): Gi Ae Kim1, Young-Suk Lim2, Jihyun An2, Danbi Lee2, Ju Hyun Shim2, Kang Mo Kim2, Han Chu Lee2, Young-Hwa Chung2, Yung Sang Lee2, Dong Jin . Suh2 |
| Institutional Author(s): |
| INSTITUTIONS (ALL): 1. Department of Internal Medicine, Asan Medical Center, Seoul, Korea, Republic of. 2. Department of Gastroenterology, Asan Medical Center, Seoul, Korea, Republic of. |
| ABSTRACT BODY: Background: Spontaneous or interferon-induced HBsAg seroclearance is durable in most patients with chronic hepatitis B (CHB). However, little is known about the durability of HBsAg seroclearance following nucleoside analogue (NUC) therapy. Methods: Among 4,578 patients who were treated with either lamivudine (n=1,924) or entecavir (n=2,654) at a tertiary referral hospital in Korea between 2000 and 2010, 121 achieved HBsAg seroclearance. Fifty-eight patients were included in this study after exclusion of 63 patients; acute hepatitis B (n=19), hepatocellular carcinoma (n=8), prior treatment with interferon (n=6), prior immunosuppressive therapy (n=17), liver transplantation (n=6), follow-up loss immediately after HBsAg seroclearance (n=5), and continued NUC therapy (n=2). Results: Mean age of 58 patients were 42 years (SD 11 years) and 41 (71%) were males. All were assumed to have HBV genotype C. At the initiation of NUC therapy, median levels of ALT and HBV DNA were 153 IU/L (interquartile range [IQR], 48-340 IU/L) and 7.0 log10 copies/mL (IQR, 3.8-8.0 log10 copies/mL), respectively. Twenty-seven (47%) had HBeAg. The median duration of NUC therapy (56 with lamivudine and 2 with entecavir) before HBsAg seroclearance was 42 months (IQR, 24-66 months). During a median follow-up period of 20 months (IQR, 12-32 months), HBsAg reversion occurred in 5 of 58 (8.6%) patients. Three of those 5 patients achieved re-clearance of HBsAg without treatment during further follow-up. The other 2 patients remained HBsAg-positive, but with low titer (< 1.0 IU/mL) and undetectable HBV DNA by PCR. Cumulative rate of anti-HBs antibody appearance was 70% at 4 years. Virologic recurrence (detectable HBV DNA by PCR) occurred in 12 of 58 (20.7%) patients. However, all of these patients maintained HBV DNA <10,000 copies/mL. No patient experienced biochemical relapse (ALT flare > x5 ULN). Conclusion: HBsAg seroclearance following NUC therapy is rare but durable in most patients with CHB after treatment discontinuation. Therefore, HBsAg seroclearance would be an ideal treatment endpoint during NUC therapy. |
| TITLE: Nucleos(t)ide analogues can be safely discontinued in chronic hepatitis B patients achieving HBsAg seroclearance |
| AUTHORS (FIRST NAME, LAST NAME): Federica Invernizzi1, Pietro Lampertico1, Alessandro Loglio1, Massimo Iavarone1, Mauro Viganò2, Floriana Facchetti1, Elena Vezali1, Giovanna Lunghi3, Massimo Colombo1 |
| Institutional Author(s): |
| INSTITUTIONS (ALL): 1. 1st Division of Gastroenterology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy. 2. Liver Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy. 3. Institute of Preventive Medicine, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. |
| ABSTRACT BODY: Background: Though chronic hepatitis B (CHB) patients achieving HBsAg seroconversion with NUCs are recommended to withdraw from therapy, still doubts exist whether this rule can be applied safely in clinical practice and in patients clearing HBsAg without seroconversion to anti-HBs. Aim: To assess the outcome of patients withdrawing from NUC therapy after HBsAg clearance. Methods: 27 out of 520 (5%) CHB patients who received NUC between 1997-2008, ultimately lost serum HBsAg and were followed for 44 (12-117) months thereafter. At the time of HBsAg clearance all patients had normal ALT, were HBeAg negative (48% HBeAg positive pre-treatment) and had undetectable HBV DNA (real time PCR < 10 IU/mL); median age was 56 years, 85% male, 52% cirrhotics, 56% genotype D, 56% CC genotype IL28B (SNP rs12979860). Eighteen (67%) patients received monotherapy (11 LAM, 3 ETV, 4 TDF) and 9 (33%) combination (5 LAM+ADV, 4 LAM+TDF); 5 (18%) were previously treated with interferon. HBsAg was quantified by Architect (Abbot Diagnostics, detection limit 0.05 IU/mL). Results: 19 (70%) patients discontinued treatment 0-41 months after HBsAg seroconversion, 7 having anti-HBs levels of 10-100 IU/mL, 6 of 100-500 IU/mL and 6 of 500->1000 IU/mL. Eight additional (30%) patients discontinued NUC therapy despite the absence of significant anti-HBs titers during a consolidation period of 27 (13-36) months, and 6 ultimately seroconverted to anti-HBs. Among the 27 patients who stopped therapy, 26 remained HBsAg seronegative during 25 (2-81) months of post-treatment follow-up, 3 (9%) showing a blip of HBV DNA ranging from 16 to 93 IU/ml without any change in anti-HBs titers, within the first 3 months off therapy. In a 49 y.o. non cirrhotic male, genotype IL28B CT, genotype D, anti-HBs negative patient, anti-HBs seroconversion was preceded by a transient reactivity for HBsAg, HBeAg and HBV DNA at month 2 off therapy. Conclusion: Patients reaching the therapeutic end point of HBsAg clearance can be safely withdrawn from NUC following either anti-HBs seroconversion or at least 12 months of a post clearance consolidation period. 患者达到HBsAg清除治疗终点,抗-HBs血清转换后或巩固期至少12个月可以安全地停止NUC |
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Co-Author Disclosure Status |
| The following authors have completed their AASLD 2012 disclosure: |
| Federica Invernizzi: Disclosure completed |
| Pietro Lampertico: Disclosure completed |
| Alessandro Loglio: Disclosure completed |
| |
| Mauro Viganò: Disclosure completed |
| Floriana Facchetti: Disclosure completed |
| Elena Vezali: Disclosure completed |
| Giovanna Lunghi: Disclosure completed |
| Massimo Colombo: Disclosure completed |
疯一点好 发表于 2013-1-7 00:27
请问楼主，你在什么医院治疗啊？
music000 发表于 2013-1-7 10:29
瞎说，目前HBV是不能被治愈的。
心路2009 发表于 2013-1-7 11:51
乙肝不治疗每年也有2%的自愈比例。你的医生手上有多少病人，你按照比例看看。如果指望胸腺肽基本不靠谱。长 ...
rick360 发表于 2013-1-7 22:52
4楼说的是目前比较流行的治疗方案，本人目前在用，联合的拉米，2个半月S抗原从208下降到98
我的主治医生手 ...
yg88 发表于 2013-1-8 12:56
你用什么联合拉米？拉米变异性大啊。。
rick360 发表于 2013-1-9 12:06
2个月DNA转阴，再接着转小三后不容易变异！
DNA也不下来，不转小三的比较容易变异
再说你联合了怎么变异 ...
zcx7797988 发表于 2013-1-10 17:09
表面抗原0.02飘过。。。
lyq2003526 发表于 2013-1-11 02:47
http://www.haodf.com/zhuanjiaguandian/xuerongnj_776248078.htm
聚乙二醇干扰素α-2a序贯核苷类药物治疗 ...
无所谓呀 发表于 2013-1-13 14:09
不知道你所说的主任医师治愈8人的概念是啥？？是临床治愈还是出现抗体痊愈呢？？ ...
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