Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral

StephenW

Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapyLiang, Y., Jiang, J., Su, M., Liu, Z., Guo, W., Huang, X., Xie, R., Ge, S., Hu, J., Jiang, Z., Zhu, M., Wong, V. W.-S. and Chan, H. L.-Y. (2011), Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy. Alimentary Pharmacology & Therapeutics, 34: 344–352. doi: 10.1111/j.1365-2036.2011.04738.x
Author Information

• 1             Department of Infectious Diseases, First Hospital, Guangxi Medical University, Nanning, China.
  
• 2             Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR.
  
  

*Dr H. L. Y. Chan, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, Shatin, Hong Kong SAR. E-mail: [email protected]

Aliment Pharmacol Ther 2011; 34: 344–352


SummaryBackground  Optimal duration of anti-viral therapy in chronic hepatitis B virus (HBV) infection remains unclear.

Aim  To investigate factors that could predict relapse after stopping anti-viral agents.

Methods  Chronic hepatitis B patients who were treated with anti-viral agents (lamivudine, adefovir, entecavir) and have stopped the treatment were recruited. Anti-viral agents were stopped according to the recommendations of the Asian Pacific Association for the Study of the Liver. Virological relapse was defined as an increase in serum HBV DNA to >1000 copies/mL after discontinuation of treatment.

Results  Eighty-four (69 treatment naïve and 15 lamivudine resistant) patients were eligible for this study. Thirty-seven patients developed virological relapse at 4.3 ± 2.9 (range 1–11) months after discontinuation of therapy. The 1-year cumulative probability of virological relapse was 42% and 47% in HBeAg (hepatitis B e antigen)-positive (n = 41) and HBeAg (hepatitis B e antigen)-negative (n = 43) patients, respectively. On multivariate analysis by Cox proportional hazard model, pre-existing lamivudine resistance, delayed suppression of HBV DNA to undetectable level during anti-viral therapy and to a higher HBsAg (hepatitis B surface antigen) level at the end of treatment were associated with virological relapse. Twelve of the 15 (80%) lamivudine resistant patients developed virological relapse. Among the 11 treatment naïve patients who had HBsAg ≤2 log IU/mL at the end of treatment, 1 (9%) of them had virological relapse.

Conclusions  Treatment cessation among lamivudine resistant patients is associated with high risk of virological relapse. Serum HBsAg level at the end of treatment and rate of HBV DNA suppression can provide supplementary information to guide the timing of stopping anti-viral drugs.

StephenW

背景
在慢性乙型肝炎病毒（HBV）感染的抗病毒治疗的最佳治疗
时间尚不清楚。

目的
探讨，可以预测抗病毒的药物，停药后复发的因素。

方法慢性乙型肝炎抗病毒的药物（拉米夫定，阿德福韦，恩替卡韦）治疗，并已停止治疗的患者被招募。根据亚洲太平洋肝脏研究协会的建议，停止抗病毒制剂。被定义为增加血清HBV DNA>1000拷贝/ ml，停药后病毒学复发。

这项研究结果88个患者（69治疗天真和15拉米夫定耐药）资格。 36名病人发达国家在4.3±2.9（范围1-11）个月后停药病毒学复发。病毒学复发，1年累积概率为42％和47％，在HBeAg阳性（乙肝e抗原）阳性（N= 41）和HBeAg（乙肝e抗原）阴性（N= 43）患者，分别。在多因素分析Cox比例风险模型，预先存在拉米夫定耐药，延迟抑制乙型肝炎病毒DNA检测不到的水平和抗病毒治疗期间，以更高的HBsAg（乙肝表面抗原）在治疗结束时的水平与病毒学复发。 15（80％）12拉米夫定耐药病人的病毒学复发。其中的11个治疗乙肝表面抗原天真≤2日志IU/ mL的患者在治疗结束后，1（9％），其中有病毒学复发。

结论
拉米夫定耐药患者的治疗停止,病毒学复发风险高。
在结束治疗时的血清HBsAg水平和HBV DNA抑制率可以提供补充信息，以指导何时停止抗病毒的药物。

咬牙硬挺

乙肝真是麻烦呢

StephenW

回复 咬牙硬挺 的帖子

一个免疫学家曾经说过：HBV是上好适应的寄生虫(superbly adapted parasite):它利用你的身体，创造出许多后代，并传染给其他宿主。还不会给你麻烦至少40-50年, 以便你一生为他服务.

把握当下

停止抗病毒治疗后乙肝复发预测

对象：

按照亚太指南核苷（拉米，阿德，恩替）抗病毒停药乙肝患者。

病毒学反弹定义：停药后血清dna>1000 copies/mL

结果 

84（69初治，15拉米耐药）名患者。

停药4.3 ± 2.9 (1–11)个月后37人发生病毒学反弹。

1年累计病毒性反弹率：42%（e抗原阳，n = 41），47%（e抗原阴，n = 43）。

治疗期间：拉米耐药，dna转阴时间过长，治疗后期s抗原升高都是反弹危险因素。

15拉米耐药患者中12人(80%)出现反弹。

11名治疗后期s抗原≤2 log IU/mL的患者中，1人 (9%)反弹。

结论

曾拉米耐药的停药患者反弹风险大。治疗后期s抗原水平和dna压制情况可为抗病毒药物停药提供初步指导信息。