J Formos Med Assoc. 2018 Dec 5. pii: S0929-6646(18)30737-X. doi: 10.1016/j.jfma.2018.11.008. [Epub ahead of print]
Taiwan consensus statement on the management of chronic hepatitis B.
Chien RN1, Kao JH2, Peng CY3, Chen CH4, Liu CJ5, Huang YH6, Hu TH4, Yang HI7, Lu SN8, Ni YH9, Chuang WL10, Lee CM4, Wu JC6, Chen PJ2, Liaw YF11.
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Abstract
The experts of Taiwan Association for the Study of Liver (TASL) have actively participated and led the guidelines on hepatitis B virus (HBV) management by Asian Pacific Association for the Study of Liver (APASL) which is the first international association for the study of liver to publish the statement on HBV management before. However, there are more and more new data on the natural history and treatment of HBV infection in the past decade. These include new application of an old biomarker (quantitative HBsAg), clinical significance of HBV genotype and naturally occurring mutations, the role of non-invasive examination in evaluating severity of hepatic fibrosis, clinical significance of outcome calculators, new drug or new combination strategies towards more effective therapy and organ transplantation including liver and non-liver transplantation. It is time to publish the guidelines on HBV management of Taiwan. Hence, TASL have conducted an expert meeting to review, to discuss and to debate the relevant literatures, followed by draft the manuscript of HBV management guidelines and recommendations. The guidelines include general management, indications for fibrosis assessment, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patient receiving immune suppression or chemotherapy and patients in the setting of liver transplantation and hepatocellular carcinoma, are also included.
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在7年内没有报道TDF耐药性.112 TDF足以治疗rtM204V / I±rtL180M HBV变异体;在治疗96周后,TDF患者为89.4%,而TDF和恩曲他滨联合治疗患者为86.3%,无法检测到HBV DNA(<69 IU / mL).124体外研究显示ADV耐药突变的单一突变,A181 T / V或N236T对TDF的敏感性几乎没有降低。然而,双突变体rtA181 V / T + rtN236T对TDF的易感性降低.125以前的研究表明,在患有A181 T / V和/或rtN236T替代的患者中,TDF的病毒抑制减少了.126然而,一项随机研究显示TDF单药治疗和TDF /恩曲他滨(FTC)联合用药治疗ADV后病毒抑制不完全的患者效果相似;基线LAM或ADV相关突变的存在不影响反应.127欧洲的一项研究表明,TDF单药治疗和TDF / FTC联合治疗在168周内将HBV DNA抑制到<400拷贝同样有效(82%和84%)在ADV难治性患者中,基线LAM / ADV耐药谱的反应没有差异.128最近一项多中心随机研究包括具有ADV耐药突变体的患者(rtA181 V / T和/或rtN236T) )在48周时,62%的HBV DNA <15 IU / mL与TDF-TDF和TDF / ETV-TDF组的63.5%相比(P = 0.88)和TDF-TDF和TDF /的64%与63.5%相比ETV-TDF组分别在第96周; (P = 0.96).129在57例多药耐药性HBV患者的病例系列中,TDF和ETV的组合在90%的患者治疗后可达到检测不到的HBV DNA(<80 IU / mL)最近的一项多中心随机研究纳入了具有ETV耐药相关突变的HBV患者,其中71%的TDF组和73%的TDF + ETV组(P> 0.99)的HBV DNA <15 IU / mL 48.131因此,TDF单药治疗在感染ETV耐药的HBV患者中提供了与TDF和ETV联合治疗相当的病毒学应答。作者: Hepbest 时间: 2018-12-13 11:06