[英语，重复 ]HBV reemerges with long-term nucleoside analog treatment

StephenW

http://www.eurekalert.org/pub_releases/2011-04/w-hbv042711.php
Hepatitis B virus reemerges with long-term nucleoside analog treatment Virological breakthrough not linked to antiviral drug resistance; non-adherence to medication likely        A recently published study revealed that virological breakthrough (VBT) is common in patients receiving nucleoside analogs (NUCs) for chronic hepatitis B. Nearly 40% of the VBTs found were not related to antiviral drug resistance. Details of this retrospective study are published in the May issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
        VBT is the first manifestation of antiviral drug resistance during NUC therapy of chronic hepatitis B. NUC drugs approved for treatment of chronic hepatitis B include lamivudine (LAM), adefovir (ADV), entecavir (ETV), telbivudine (TBV), and tenofovir (TDF). While the medications suppress the virus with few side effects, they do not eradicate HBV and require long-term treatment to provide clinical benefit. With long-term NUC therapy, studies have shown an increasing risk of drug resistance particularly with monotherapy regimens.
        In the current study, Anna Lok, M.D. and colleagues from the University of Michigan Health System examined the incidence of VBT and genotypic resistance (GR) in 148 patients with chronic hepatitis B who were treated with NUCs between January 2000 and July 2010. The mean age of study participants was 45 years and 73% were male. Researchers reviewed medical records and recorded patient demographics, hepatitis B virus (HBV) markers, liver panel, blood counts and liver histology.
        Results showed that during a mean follow-up of 38 months, 39 (26%) patients had at least one VBT, and upon retesting, 15 (38%) of these patients did not have a VBT and 10 had no evidence of GR. Researchers reported the probability of VBT, confirmed VBT, and GR at five years was 46%, 30%, and 34%, respectively. "Our analysis showed an alarmingly high rate of VBT in clinical practice and the only factor significantly linked to VBT was failure to achieve undectectable HBV DNA," said Dr. Lok.
        HBV DNA decreased in the ten patients who initially experienced a VBT, but who did not have confirmed VBT or GR, when the same drug regimen was maintained. Nine of these patients had undetectable HBV DNA at the most recent follow-up, a mean of 7 months after the initial VBT. These data suggest that nonadherence to medication may be a common cause of VBT. "Counseling patients with chronic hepatitis B on the importance of medication adherence, and confirming reemergence of the virus and genetic mutations that cause resistance, can help to avoid unnecessary changes to antiviral treatments," advised Dr. Lok.
       

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        Article: "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 and Anna S.F. Lok. Hepatology; Published Online: March 24, 2011 (DOI: 10.1002/hep.24318); Print Issue Date: May 2011. http://onlinelibrary.wiley.com/doi/10.1002/hep.24318/abstract.
        This study is published in Hepatology. Media wishing to receive a PDF of the articles may contact [email protected].




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StephenW

乙型肝炎病毒reemerges长期核苷类似物治疗
病毒学突破不挂抗病毒药物耐药性;不遵守用药可能

最近发表的一项研究显示，病毒学突破（VBT组）在接受慢性乙型肝炎（NUCs）核苷类似物的患者常见的近40％的VBTs发现的不相关的抗病毒药物的耐药性。本回溯性研究的详情载于肝脏病，由Wiley - Blackwell的刊载于协会代表美国肝病研究的一本杂志五月号。

VBT组是在国统会抗病毒药物耐药的慢性乙型肝炎国统会的批准治疗慢性乙型肝炎的药物治疗的第一表现，包括拉米夫定（林），阿德福韦（2009/07），恩替卡韦（Entecavir），替比夫定，和替诺福韦。虽然抑制药物副作用少的病毒，他们不消除乙肝病毒，需要长期治疗，提供临床益处。随着长期国统会治疗，研究显示，特别是单一治疗方案的耐药性的危险增加。

在目前的研究，安娜乐，MD和从密歇根大学健康系统的同事们审查了VBT组和基因型阻力（GR）的慢性乙型肝炎148例与NUCs处理谁是2000年1月2010年7月发生。研究参与者的平均年龄为45岁和73％为男性。审查医疗记录，并记录病人的人口统计资料研究，乙型肝炎病毒（HBV）的标志物，肝面板，血球计数和肝组织学。

结果表明，在平均随访38个月，39（26％）患者至少有一个注册VBT组，并呼吁重新测试，这些患者中15（38％）没有一个VBT组10例无遗传资源的证据。研究人员报告了VBT组的可能性，证实VBT组，并在五年遗传资源为46％，30％和34％，分别为。 “我们的分析表明了VBT组惊人的速度在临床实践中，唯一以VBT组显着相关的因素是无法实现undectectable乙型肝炎病毒DNA，”乐博士说。

乙肝病毒DNA的下降，10例谁最初经历了VBT组，但谁没有证实VBT组或遗传资源，当相同的药物维持治疗方案。这些患者中，有9个在最近的后续行动，初步VBT组后的平均7个月，HBV DNA转阴。这些数据表明，未遵从药物可能是VBT组的常见原因。 “与坚持的药物治疗慢性乙型肝炎的重要性，并确认该病毒而导致耐药基因突变，可以帮助避免不必要的改变重现辅导抗病毒治疗的病人，”劝乐博士。

＃＃＃

文章：“病毒学突破和抵抗的患者接受治疗慢性乙型肝炎核苷（酸）类似物在临床实践中。” Chanunta Hongthanakorn，Watcharasak Chotiyaputta，凯利Oberhelman，罗伯特丰塔纳，豪尔赫答马雷罗，特雷西利卡里和安娜科幻乐。肝脏病;发表时间：2011年3月24日（分类号：10.1002/hep.24318）;打印发行日期：2011年5月。 http://onlinelibrary.wiley.com/doi/10.1002/hep.24318/abstract。

这项研究发表在杂志。媒体希望得到一个PDF格式的文章，可致电[email protected]。