Nucleot(s)ide analogues to prevent perinatal transmission of HBV: Lamivudine is

StephenW

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06828.x/pdf

Nucleot(s)ide analogues to prevent perinatal transmission of HBV: Lamivudine is effective but Tenofovir may be better.
J LAWLER,1 A GLASS,1 U CHATTERJEE,2 E WISEMAN,1
S DAVISON,1 S MANOHARAN,2 L SMITH,1 A YEO,3
A AYRES,4 S LOCARNINI,4 MT LEVY1
1 Department Gastroenterology and Hepatology,
Liverpool Hospital, 2 University of New South Wales,
Sydney, 3 Ingham Research Institute, 4 Victorian
Infectious Disease Reference Laboratory
Perinatal transmission of HBV still occurs despite passive/active immune prophylaxis. We have previously reported a vertical transmission rate approaching 10% in mothers with viral loads above HBV DNA log8
copies/mL (∼/=log7 IU/mL). Lamivudine in the last trimester may reduce this risk. The efficacy of Tenofovir has not been proven.
Aim
To examine the impact of Lamivudine and Tenofovir used in the last trimester of pregnancy.
Methods
We conducted a prospective opt-in study of pregnant women with a high viral load. Women were offered Lamivudine commencing at 32 weeks gestation and more recently Tenofovir. We compared viral load response between Lamivudine and Tenofovir. Viral load quantitation was performed prior to treatment and at delivery (or within two weeks).
Perinatal transmission was assessed at 9 months of age.
Results
44 women were treated with Lamivudine, 8 women were treated with Tenofovir and 15 women opted out serving as controls. Virological assessments at both baseline and delivery were available for 25 Lamivudine treated mothers and 6 Tenofovir treated mothers. There was no significant difference in median baseline viral load between treatment groups [Lamivudine: 170,000,000 IU/mL (95%CI: 71,000,000–248,000,000);
Tenofovir: 60,200,0000 IU/mL (95%CI: 654,000–170,000,000), p = 0.14].
The median end-of-treatment viral load was significantly lower in the Tenofovir group [Lamivudine: 234,000 IU/mL (95%CI: 149,000–682,000); Tenofovir: 16,450 IU/mL (95%CI: 5,080–86,000), p = 0.0087].
Median duration of therapy (50 vs 63.5 days) was not significantly different (p = 0.15). End-of-treatment HBV DNA was >log7 IU/mL in 5/25 mothers treated with Lamivudine versus 0/6 in the Tenofovir group. 2/7
control group babies tested HBsAg positive compared with 0/27 babies from the Lamivudine treated group (p = 0.04). No baby has reached 9 months of age in the Tenofovir group.
Conclusions
Lamivudine is effective but failed to achieve adequate viral suppression in 20% of women treated. We hypothesise a role for transplacental transfer of drug which has a protective effect at the time of birth exposure. Tenofovir provides more effective viral load reduction and may be a superior choice.

StephenW

谷歌翻译是不是100％准确，仅供参考使用。
Nucleot(S)IDE类似物，以防止乙肝母婴传播：拉米夫定是有效的，但泰诺福韦可能会更好。

J LAWLER,1 A GLASS,1 U CHATTERJEE,2 E WISEMAN,1
S DAVISON,1 S MANOHARAN,2 L SMITH,1 A YEO,3
A AYRES,4 S LOCARNINI,4 MT LEVY1


1部胃肠病学和肝病学杂志，利物浦医院，
2新南威尔士大学，悉尼，
3英厄姆研究所，
4维多利亚传染病参考实验室

尽管被动/主动免疫预防乙肝病毒母婴传播仍然出现。我们曾报道了一个垂直传播率接近10％母亲的病毒载量的乙肝病毒DNA的log8 拷贝/ mL（〜/ = log7国际单位/毫升）以上。拉米夫定在怀孕的最后三个月，可能会减少这种风险。替诺福韦的疗效尚未得到证实。
目标
要检查在怀孕的最后三个月使用拉米夫定和泰诺福韦的影响。
方法
我们进行了一项前瞻性的选择研究与病毒载量高的孕妇。拉米夫定在妊娠32周开始，最近泰诺福韦妇女提供。我们相比拉米夫定和替诺福韦的病毒载量的响应。病毒载量定量进行治疗前和分娩时（或在两个星期之内）。
母婴传播是评估在9个月的年龄。
结果
拉米夫定治疗的44名妇女，8名妇女被替诺福韦治疗，并选择了15名妇女作为对照组的。在基线和交付的病毒学评估25拉米夫定治疗的母亲和6泰诺福韦治疗母亲。中位数治疗组之间的基线病毒载量没有显着差异[拉米夫定：170,000,000 IU /毫升（95％CI：71,000,000-248,000,000）;
泰诺福韦：60,200,0000国际单位/毫升（95％CI：654,000-170,000,000），P = 0.14]。
在替诺福韦组中位数治疗结束病毒载量显着降低[拉米夫定：234,000 IU /毫升（95％CI：149,000-682,000）;泰诺福韦：16,450国际单位/毫升（95％CI：5,080-86,000），P = 0.0087]。
治疗期间中位数（50比63.5天）没有显着差异（P = 0.15）。治疗HBV - DNA> log7 IU /毫升比0 / 6泰诺福韦组与拉米夫定治疗5 / 25母亲。 2 / 7
对照组婴儿HBsAg阳性与拉米夫定治疗组（P = 0.04）0 / 27婴儿相比，进行了测试。没有宝宝已经达到了9个月的年龄在替诺福韦组。
结论
拉米夫定是有效的，但未能达到足够的抑制病毒治疗的妇女在20％。我们hypothesise在出生曝光时有保护作用的药物的胎盘转移的作用。泰诺福韦提供更有效的病毒载量下降，可能是一个更好的选择。

大哥是空军

你这怎么翻译的?看不懂呀.

把握当下

结论：拉米有效，但是对20%女性的病毒抑制不充分。我们猜测在婴儿出生时药物可经过胎盘起到有效的保护作用。替诺对病毒抑制更有效因此可能是更好的选择
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1. 拉米有效，但是对20%女性的病毒抑制不充分：根据文章实验结果，用药三个月后拉米组（一共25人）有5人dna仍在7次方以上

2. 替诺对病毒抑制更有效因此可能是更好的选择：根据文章实验结果，表抗阳性孕妇观察组（未用药）7人，其中2人婴儿被传染，因此如果拉米没有奏效，仍然可能母婴传染

3. 替诺可能是更好选择：这个研究都是在婴儿9个月大时进行检查，这时拉米已经有数据，但是使用替诺孕妇的孩子在文章发表时还没有到9个月的，所以只是说“可能”

把握当下

上面说的几个数字：

End-of-treatment HBV DNA was >log7 IU/mL in 5/25 mothers treated with Lamivudine versus 0/6 in the Tenofovir group

2/7 control group babies tested HBsAg positive compared with 0/27 babies from the Lamivudine treated group (p = 0.04)

No baby has reached 9 months of age in the Tenofovir group.

StephenW

回复 把握当下 的帖子

但是使用替诺孕妇的孩子在文章发表时还没有到9个月的，所以只是说“可能”
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我很欣赏你这个的翻译

把握当下

StephenW 发表于 2011-8-27 21:23
回复 把握当下 的帖子

但是使用替诺孕妇的孩子在文章发表时还没有到9个月的，所以只是说“可能”

谢谢，刚才发现20%那个的人数我算错了所以改了一下

9个月这个虽然没有数据但是可以预见如此，所以作者没等到数据就发表文章了

其实我更想看的是副作用比例，不过考虑到这个研究是小型的，应该不会涉及到

StephenW

回复 把握当下 的帖子

Yes, the results for the babies whose mothers took Tenofovir are not known at the time they submit their paper. Judging by the fact that all the mothers achieved response to Tenofovir, I am hopeful all the babies will be immune. It is interesting that you have to wait 9 months to see whether the vaccine worked.


That sentence can mean all the children die before they reach 9 months