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本帖最后由 风雨不动 于 2012-4-14 15:28 编辑
<http://onlinelibrary.wiley.com/doi/10.1002/hep.24318/abstract?systemMessage=Wiley>+Online+Library+will+be+disrupted+2nd+Apr+from+10-12+BST+for+monthly+maintenance
Viral Hepatitis
Virological breakthrough and resistance in patients with chronic hepatitis
B receiving nucleos(t)ide analogs in clinical practice
Chanunta Hongthanakorn, Watcharasak Chotiyaputta, Kelly Oberhelman, Robert
J. Fontana, Jorge A. Marrero, Tracy Licari, Anna S.F. Lok,†DOI:
10.1002/hep.24318
Copyright © 2011 American Association for the Study of Liver Diseases
Issue
Hepatology
Accepted Article (Accepted, unedited articles published online for future
issues)
Abstract
Virological breakthrough (VBT) is the first manifestation of antiviral drug
resistance during nucleos(t)ide analog (NUC) treatment of chronic hepatitis
B (CHB) but not all VBTs are due to drug resistance. The aims of this study
were to determine the incidence of virological breakthrough (VBT) and
genotypic resistance (GR) in CHB patients receiving NUCs in clinical
practice. Records of CHB patients receiving NUCs were reviewed. All
patients with VBT were tested for drug resistance mutations. Of 148
patients included, 73% were men, mean age was 44.9 years. During a mean
follow-up of 37.5±20.1 months, 39 (26%) patients had at least 1 VBT. Of
these 39 patients, 15 (38%) were not confirmed to have VBT on retesting and
10 of these 15 had no evidence of GR. The cumulative probability of VBT,
confirmed VBT, and GR at 5 years was 46.1%, 29.7%, and 33.9%, respectively.
In multivariate analysis, failure to achieve undetectable HBV DNA was the
only factor significantly associated with VBT. Among the 10 patients who
had VBT but no confirmed VBT or GR and who were maintained on the same
medications, serum HBV DNA decreased in all 10 and 9 had undetectable HBV
DNA a mean of 6.8 months after the VBT. Four patients had persistently
undetectable HBV DNA while six had transient increase in HBV DNA during
follow-up but none had GR.
Conclusion: VBT was common in CHB patients receiving NUCs in clinical
practice, but nearly 40% of the VBTs were not related to antiviral drug
resistance. Counseling of CHB patients on medication adherence and
confirmation of VBT and/or GR can avoid unnecessary changes in antiviral
medications.
(HEPATOLOGY 2011.)
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发表于 2011-3-30 20:56
