EASL2012:Antiviral therapy can lead to fibrosis regression in antiHBe-positive c

StephenW

Abstract               
                                

Title	Antiviral therapy can lead to fibrosis regression in antiHBe-positive chronic hepatitis B patients treated in clinical practice
Speaker:	Nikolaos   Papachrysos
Author:	N. Papachrysos1*, P. Hytiroglou2, L. Papalavrentios1, E. Sinakos1, I. Kouvelis1, E. Akriviadis1
Affiliation:	1Fourth Unit of Internal Medicine, Aristotle University of Thessaloniki, 2Department of Pathology, Aristotle University, Medical School, Thessaloníki, Greece. *[email protected]
Background and aims: Treatment with nucleos(t)ideanalogs (NUCs) or interferon-α (IFNα) suppresseshepatitis B virus (HBV) replication and can delay disease progression. Reportsof long-term results of antiviral agents on liver histology have been sparseand involve mostly patients enrolled in randomized trials or HBeAg-positivepatients of Asian origin. We sought to determine hepatic histologic changes in antiHBe-positivechronic hepatitis B (CHB) patients under long-term antiviral treatment inclinical practice. Methods: First liver biopsywas performed at the onset of therapy and repeat biopsy after prolongedantiviral treatment including lamivudine in all patients. Due to viralresistance a nucleotide analog was added in 11 patients (adefovir n=8, tenofovirn=3). Five patients initially received a 12-month course of pegylated IFNα, followed byNUCs. The mean biopsy length was 18mm in the first biopsy and 28mm in thesecond. Necroinflammatory activity was graded as 1-minimal (HAI: 0-3), 2-mild(HAI: 4-8), 3-moderate (HAI: 9-12), or 4-severe (HAI: 13-18); staging wasaccording to METAVIR system. Results: Dataon 34 antiHBe-positive Caucasian patients (17 male, mean age at first biopsy 47±9.4 years) with paired biopsies were analyzed. Mean interval between biopsieswas 71.7±26.9 months. Improvement in activity was seen in 24/34 patients (71%)(drop of -1.06 grade, SD=1.2), and in stagein 18/34 patients (53%) (drop of -0.62 stage, SD=0.8). Importantly, regressionof early cirrhosis (initial stage F4) was observed in 2 patients (one to F2 andanother one to F1). Worsening of stage was observed in only two cases.Transient development of resistance to lamivudine, observed in 11 (32%)patients, was not associated with lack in fibrosisimprovement (p=0.54). Conclusions: Sustained HBV suppression with antiviral treatment in antiHBe-positive patientscan lead to improvement of necroinflammatory activity in most cases and toamelioration of stage in more than 50%, regardless of the transient occurrenceof viral breakthrough. Potent antivirals in common clinical use for CHB can evenimprove early cirrhosis.

StephenW

在antiHBe阳性慢性乙型肝炎治疗的患者在临床实践中，标题抗病毒治疗可导致肝纤维化回归
主讲人：古拉斯Papachrysos
作者：北Papachrysos1 * P. Hytiroglou2，L. Papalavrentios1，E. Sinakos1，I. Kouvelis1，大肠杆菌Akriviadis1
单位：1Fourth单位内科，萨洛尼卡亚里士多德大学，病理学教研室，希腊塞萨洛尼基亚里士多德大学医学院。 * [email protected]
背景和目标：核苷（酸）IDE类似物（NUCs）的α-干扰素（α干扰素）治疗，抑制乙肝病毒（HBV）的复制，可延缓病情恶化。肝脏组织学上的抗病毒药物的长期结果的报告已经稀疏，涉及多数患者在随机试验或亚洲血统的HBeAg阳性患者。我们试图确定antiHBe阳性慢性肝炎（CHB）在长期的抗病毒治疗的病人在临床实践中的肝组织学变化。
方法：首先进行肝活检在治疗开始后，所有患者的长期抗病毒治疗，包括拉米夫定重复活检。由于病毒性11例（阿德福韦N = 8，替诺福韦N = 3）中添加了核苷酸的模拟。五名病人最初收到12个月的聚乙二醇干扰素α当然，NUCs。平均活检长度是18毫米的的在第一次活检和第二28毫米的。坏死性炎症活动分级为1最小（海：0-3），2轻度（黄淮海4-8），中度（海：9-12），或4严重（黄淮海：13-18）;分期是根据METAVIR系统。
结果：34 antiHBe积极白人患者的数据（男性17名，平均年龄在第一次活检47±9.4岁）配对活检进行分析。之间的平均活检间隔为71.7±26.9个月。改进的活动被视为在24/34例（71％）（下降-1.06级，SD = 1.2），并在18/34例（53％）（下降-0.62阶段，SD = 0.8）的阶段。重要的是，早期肝硬化的回归（初始阶段F4），观察2例（F2和另一个到F1）。只有两种情况恶化的阶段，观察。拉米夫定，11（32％）患者的观察，抗瞬态发展缺乏纤维化改善（P = 0.54）是不相关的。
结论：持续与在antiHBe阳性患者的抗病毒药物治疗乙肝病毒抑制可导致坏死性炎症活动在大多数情况下，改善和改良阶段，在50％以上，无论瞬态发生病毒突破。常见的慢性乙型肝炎的临床使用强效抗病毒药物，甚至可以提高早期肝硬化。

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