HBV Journal Review June 1, 2012, Vol 9, no 6 by Christine M. Kukka

StephenW

HBV杂志回顾 2012年6月1日，第9卷，第6

编辑
Christine M Kukka

全部下载在这里：
下面摘录:
Combination of Antiviral and Chinese Traditional Medicine Proves Effective
Chinese researchers treated 164 patients with either the antiviral entecavir (Baraclude) or a combination of entecavir and the Chinese traditional medicine Shenxian yiganling to see if the Western drug and traditional Chinese medicine together would be more effective than entecavir alone.

According to the report published in the Chinese journal of integrated traditional and Western medicine (PMID:22574588), the combination treatment was nearly twice as effective at clearing the hepatitis B "e" antigen (HBeAg) than entecavir alone.

Entecavir is an antiviral that meddles with the HBV genetic material so it cannot replicate.

After 48 weeks of treatment, there was little difference in two patient groups' alanine aminotransferase (ALT) levels (about 70% of both groups had normal ALTs, indicating no liver damage.) About 73% of both groups achieved undetectable HBV DNA. However, substantially more patients in the combined therapy group lost HBeAg and developed "e" antibodies, called seroconversion.

Researchers reported that 39.44% of the combination group lost HBeAg, compared to 23.75% of the entecavir-only group. Additionally, 32.39% lost HBeAg and developed "e" antibodies, compared to 15% in the entecavir-only group.

"Entecavir combined with Shenxian yiganling promoted the HBeAg ... conversion rate, possibly through the recovery of the immune functions," researchers wrote.

Another study in this publication described the treatment of 240 patients with either just the antiviral adefovir (Hepsera), or with adefovir combined with a baihua xianglian detoxification liquid for 48 weeks.

By the end of the treatment period, the undetectable HBV DNA rate was 29% in the adefovir-only group compared to 55% in the combined treatment group. The HBeAg seroconversion rate was 22% in the combination group and 12% in the adefovir-only group.
抗病毒和中国传统医学相结合，证明有效
中国研究人员的抗病毒药物恩替卡韦（博路定）或恩替卡韦的组合和中国传统医药莘县益肝灵西药和传统中药一起将仅高于恩替卡韦更有效治疗的164例患者。

据中国中西医结合医学杂志（分类号：22574588）公布的报告显示，联合治疗了近两倍，有效清除肝炎B“的E”仅高于恩替卡韦抗原（HBeAg阳性）。

恩替卡韦是一种抗病毒药物，乙肝病毒的遗传物质插手，所以它无法复制。

经过48周的治疗后，有两个病人组的谷丙转氨酶（ALT）水平（约70％，两组有正常的低价竞标，表示肝功能损害。）相差不大，约73％，两组达到检测不到乙肝病毒DNA。然而，在联合治疗组的患者大幅度增加丢失HBeAg和开发的“E”的抗体，称为血清转换。

研究人员报告，39.44％，联合组HBeAg的丢失，仅恩替卡韦组的23.75％相比。此外，32.39％，失去了HBeAg和发达国家的“e”抗体相比，仅恩替卡韦组15％。

“莘县益肝灵联合恩替卡韦促进e抗原转换率，可能通过免疫功能的恢复，”研究人员写道。

本出版物中的另一项研究中所述的240例患者的治疗与抗病毒药物阿德福韦（阿德福韦酯），或与阿德福韦48周与百花香莲解毒液体相结合。

治疗期间，检测不到乙肝病毒DNA率为29％，的阿德福韦只组相比，联合治疗组的55％。 HBeAg血清转换率联合组为22％和12％，在的阿德福韦只组。

StephenW

Cholesterol-Lowering Drugs Help Patients with Cirrhosis
A small study found that when patients with cirrhosis and heart disease were given statins (cholesterol-lowering drugs), the medication helped heart disease and it appears to reduce liver damage.

Brigham & Women’s Hospital researchers followed 81 patients with both cirrhosis (intense liver scarring) and heart disease who were given statins for three months and then followed for up to three years. Their health was compared to a control group of 162 patients who did not receive statins.

Only 38.2% of patients on statins experienced worsening liver disease, compared to 50.6% of patients in the untreated, control group. Additionally, there were fewer deaths in the statin-treated group.

"Contrary to the prior belief that statins aren't safe in patients with cirrhosis, we found they actually may be beneficial in this population," researchers noted, when they presented their findings at the Digestive Disease Week conference.

Doctors have feared statins were unsafe in patients with liver disease because statins are metabolized in the liver and may put patients at greater risk of liver disease and failure.

This and other recent studies suggest statins are safe and may even lessen liver decompensation.

降胆固醇药物帮助肝硬化患者
一项小规模研究发现，肝硬化和心脏疾病的患者给予他汀类药物（降胆固醇药），服药帮助心脏疾病，它似乎减少肝损伤。

布里格姆及妇女医院的研究人员随后都肝硬化（激烈肝脏结疤）和心脏疾病者分别给予3个月内，他汀类药物，然后长达三年的81例。相比，他们的健康对照组的162谁不接受他汀类药物的患者。

只有38.2％的患者对他汀类药物的经历肝病恶化，50.6％的患者进行治疗，对照组相比。此外，还有在他汀类药物治疗组的死亡人数减少。

“他汀类药物在肝硬化患者安全之前的信念相反，我们发现他们实际上可能有利于在这个人口，”研究人员指出，当他们在消化疾病周会议提出他们的研究结果。

医生们担心他汀类药物在肝病患者不安全的，因为他汀类药物在肝脏代谢，可能使患者的肝脏疾病和失败的风险更大。

这和其他最近的研究表明他汀类药物是安全的，甚至可以减轻肝功能失代偿。

StephenW

New Hepatitis B Treatment Guidelines Released
The European Association for the Study of the Liver recently published new treatment guidelines in the Journal Hepatology, and experts have published new treatment recommendations in the May issue of Current Opinion in Gastroenterology. Here is a summary of both sets of recommendations:

     Should young, HBeAg-positive patients with normal ALT levels and high viral load be treated? The European guidelines suggest that patients under age 30 with no family history of liver cancer, do not need treatment nor a liver biopsy. However, monitoring their liver health is recommended every three to six months.

    Should adult HBeAg-negative patients with normal ALTs and low viral load be treated? Test these patients every three months for one year, if their HBV DNA remain below 2,000 international units per milliliter (IU/mL), then neither a biopsy nor treatment is needed. If semi-annual testing reveals no liver damage over three years, then annual or semi-annual testing is recommended.

    If viral load and ALTs are elevated, is a liver biopsy needed before starting treatment? No, but a non-invasive method for assessing fibrosis or cirrhosis may be useful.

    Should patients with compensated cirrhosis and detectable HBV DNA be treated even if ALT levels are normal? Yes.

新的乙肝治疗指南发布
欧洲肝脏研究协会最近公布的新的治疗准则，在杂志肝病，专家们发表在5月消化当前舆论问题的新的治疗建议。这里是一个总结这两套建议：

     要年轻，HBeAg阳性，ALT水平正常的患者和病毒载量高，可以治疗吗？欧洲的指引建议，无肝癌家族史的30岁以下的患者，不需要治疗，也不不需要肝穿。然而，监测其肝脏健康，建议每三至六个月。

    成人HBeAg阴性患者与正常的ALT和病毒载量低,应该治疗？
测试这些病人每3个月为一年，如果他们的HBV DNA仍低于每毫升2000国际单位（IU /毫升），不需要肝穿，也不必要治疗的。如果半年度测试结果显示没有肝损害,超过三年的肝功能损害，然后建议年度或半年度测试。

    如果病毒载量和ALT升高，开始治疗前肝活检需要吗？否，但非侵入性的方法评估肝纤维化或肝硬化可能是有用的。

   代偿期肝硬化患者和病毒DNA检测到应治疗吗，即使ALT水平是正常的？是。

StephenW

EASL Guidelines Chart Drug Treatment Success Rates in Hepatitis B Patients
The following success rates, published in the latest EASL Clinical Practice Guidelines, are for HBeAg-positive patients who received these drugs for 12 months.

Pegylated interferon:

    HBeAg seroconversion (loss of "e" antigen, development of "e" antibody): 32%
    Achieved undetectable HBV DNA: 14%
    Achieved normal ALT levels, indicating no liver damage: 41%
    Lost hepatitis B surface antigen (HBsAg): 3%

Lamivudine (Epivir-HBV), which is rarely used due to its high rate of drug resistance:

    HBeAg seroconversion 16-18%.
    Undetectable  HBV DNA: 36-44%
    Normal ALTs: 41-72%
    Loss of HBsAg: 0%

Telbivudine (Tyzeka):

    HBeAg seroconversion: 22%
    Undetectable  HBV DNA: 60%
    Normal ALTs: 77%
    Loss of HBsAg: 0.5%

Entecavir (Baraclude):

    HBeAg seroconversion: 21%
    Undetectable  HBV DNA: 67%
    Normal ALTs: 68%
    Loss of HBsAg: 2%

Adefovir (Hepsera):

    HBeAg seroconversion: 22%
    Undetectable  HBV DNA: 12-18%
    Normal ALTs: 48-54%
    Loss of HBsAg: 0%

Tenofovir (Viread):

    HBeAg seroconversion: 21%
    Undetectable  HBV DNA: 76%
    Normal ALTs: 68%
    Loss of HBsAg: 3%

Treatment outcomes for HBeAg-negative patients, after 12 months of treatment, by drug:

Pegylated interferon:

    Undetectable  HBV DNA: 19%
    Normal ALTs: 59%
    Loss of HBsAg: 4%

Lamivudine (Epivir-HBV), which is rarely used due to its high rate of drug resistance:

    Undetectable  HBV DNA: 72-73%
    Normal ALTs: 71-79%
    Loss of HBsAg: 0%

Telbivudine (Tyzeka):

    Undetectable  HBV DNA: 88%
    Normal ALTs: 74%
    Loss of HBsAg: 0%

Entecavir (Baraclude):

    Undetectable  HBV DNA: 90%
    Normal ALTs: 78%
    Loss of HBsAg: 0%

Adefovir (Hepsera):

    Undetectable  HBV DNA: 51-63%
    Normal ALTs: 72-77%
    Loss of HBsAg: 0%

Tenofovir (Viread):

    Undetectable  HBV DNA: 93%
    Normal ALTs: 76%
    Loss of HBsAg: 0%

欧洲肝病学会指引图表乙型肝炎患者的药物治疗成功率
以下的成功率，在最新的欧洲肝病学会临床实践指南的出版，
HBeAg阳性患者, 经过12个月的治疗药物，治疗效果。

聚乙二醇干扰素：

    HBeAg血清转换（损失的“e”抗原，开发的“e”抗体）：32％
    实现检测不到乙肝病毒DNA：14％
    实现ALT水平正常，表示肝功能损害：41％
   
消失乙型肝炎表面抗原（HBsAg）：3％

拉米夫定（拉米HBV）的，这是很少使用，由于其高耐药率：

    HBeAg血清转换的16-18％。
    检测不到HBV DNA的36-44％
    正常ALTS：41-72％
    HBsAg消失：0％

替比夫定（TYZEKA）：

    HBeAg血清转换：22％
    检测不到乙肝病毒DNA：60％
    正常ALTS：77％
    HBsAg消失：0.5％

恩替卡韦（博路定）：

    HBeAg血清转换：21％
    检测不到乙肝病毒DNA：67％
    正常ALTS：68％
    HBsAg的损失：2％

阿德福韦（阿德福韦酯）：

    HBeAg血清转换：22％
    检测不到HBV DNA的12-18％
    正常ALTS：48-54％
    HBsAg消失：0％

泰诺福韦（VIREAD）：

    HBeAg血清转换：21％
    检测不到乙肝病毒DNA：76％
    正常ALTS：68％
    HBsAg消失：3％

HBeAg阴性的患者，经过12个月的治疗药物，治疗效果：

聚乙二醇干扰素：

    检测不到乙肝病毒DNA：19％
    正常ALTS：59％
    HBsAg消失：4％

拉米夫定（拉米HBV）的，这是很少使用，由于其高耐药率：

    检测不到HBV DNA的72-73％
    正常ALTS：71-79％
    HBsAg消失：0％

替比夫定（TYZEKA）：

    检测不到乙肝病毒DNA：88％
    正常ALTS：74％
    HBsAg消失：0％

恩替卡韦（博路定）：

    检测不到乙肝病毒DNA：90％
    正常ALTS：78％
    HBsAg消失：0％

阿德福韦（阿德福韦酯）：

    检测不到HBV DNA的51-63％
    正常ALTS：72-77％
    HBsAg消失：0％

泰诺福韦（VIREAD）：

    检测不到乙肝病毒DNA：93％
    正常ALTS：76％
    HBsAg消失：0％

StephenW

Treatment for Pregnant Women:
According to the report in Current Opinion in Gastroenterology, of 2,356 children born to HBV-infection mothers, 9.26% of those born to HBeAg-positive mothers became infected despite receiving hepatitis B immunoglobulin (HBIG) and three hepatitis B vaccine doses.

The infection rate was so low (less than 1%) in children born to HBeAg-negative mothers that HBIG did not appear to offer any additional protection beyond vaccination.

In order to decrease mother-to-child transmission, HBeAg-positive mothers with high viral loads can be treated with either tenofovir or telbivudine during their third trimester, experts recommend in the "New Advanced in Chronic Hepatitis B." Pregnant women should not use interferon during pregnancy because of safety concerns.

According to the new EASL guidelines, if a woman receiving antiviral treatment for advanced fibrosis or cirrhosis becomes pregnant, she should continue treatment with either tenofovir or telbivudine. Both drugs have been shown to be very safe when used by HIV-infected women during pregnancy.

The safety of breastfeeding while taking antivirals is not clear, according to EASL. "Tenofovir concentrations in breast milk have been reported," but the amount is so small it should not post threats to infants," according to the report.

孕妇的处理：
根据当前意见的报告中，2,356名儿童乙肝病毒感染的母亲所生，在胃肠，9.26％的HBeAg阳性的母亲所生的被感染，尽管接受B型肝炎免疫球蛋白（HBIG）和3个B型肝炎疫苗。

感染率是如此之低（小于1％），球蛋白并未提供额外的保护以外的任何疫苗接种HBeAg阴性母亲所生子女。

为了减少母亲传染​​给孩子，高病毒载量与HBeAg阳性的母亲可以孕晚期期间他们要么替诺福韦或替比夫定治疗，专家建议在“高级慢性乙型肝炎”孕妇不宜使用干扰素怀孕期间，因为对安全的关切。

根据新的欧洲肝病学会准则，接受抗病毒药物治疗晚期肝纤维化或肝硬化，如果一个女人怀孕，她应该继续或者替诺福韦或替比夫定治疗。这两种药物已被证明是非常安全的，当感染艾滋病毒的妇女在怀孕期间使用。

母乳喂养的同时服用抗病毒药物的安全性是不明确的，按照欧洲肝病学会。 “泰诺福韦母乳中的浓度已报道，”但数量是如此之小，它不应该构成任何威胁到婴幼儿“，根据该报告。

StephenW

28% of Vaccinated Children Born to HBV-Positive Mothers Still Have HBV DNA
Iranian researchers screened 75 children for HBV DNA—expecting to find no signs of HBV infection—and INSTEAD found 28% testing positive despite the presence of the surface antibody.
All of the children had been born to HBV-positive mothers and had received both the vaccine and HBIG after birth. Due to the immunization, all tested positive for the surface antibody and researchers assumed they were free of infection.

However, when their blood was screened, HBV DNA was detected in 21 of the 75 children. Viral load was low, ranging from 77 to 9,240 copies/mL. Thirteen of the children had some type of viral mutation.

"HBV occult (hidden, without HBsAg) infection seems to be relatively frequent in immunized children born to HBsAg-positive mothers," the researchers reported in the May issue of the Journal of Hepatology. They encouraged doctors to screen children born to infected mothers for occult hepatitis B infections, even when they appeared to be free of infection and testing positive for the surface antibody.
28％的HBV阳性母亲所生的儿童接种疫苗仍然有乙肝病毒的DNA
伊朗研究人员筛选HBV DNA的发现，尽管表面抗体的存在没有感染乙肝病毒的迹象，却发现28％检测阳性的75名儿童。
所有的孩子都已经HBV阳性母亲所生，并获得了出生后乙肝免疫球蛋白和疫苗。由于免疫，所有药检呈阳性的表面抗体和研究人员认为他们感染。

然而，当他们的血液筛选，HBV  -  DNA检测的75名儿童中有21。病毒载量低，范围从77至9,240拷贝/ ml。 13个孩子，有一些病毒突变类型。

“隐匿性乙肝病毒（隐藏，无HBsAg）的感染似乎是免疫接种的儿童HBsAg阳性母亲所生的比较频繁，”研究人员报告在5月发出的肝脏病杂志。他们鼓励医生到屏幕隐匿性乙肝感染者感染的母亲所生的儿童，即使他们似乎是表面抗体阳性的感染和测试。

StephenW

HBV Genotype May Dictate Severity of Infection
Increasingly, researchers are studying what impact genotype plays in the progression of HBV infection.

Recently, Swedish researchers followed HBsAg, HBeAg, ALT and viral load over 9.2 years in 124 untreated adults. According to their report published in the Journal of Clinical Virology:

    HBV DNA levels decreased significantly in patients with genotype A, B and D, but not in those with genotype C.
    Loss of HBeAg was seen in 44% of patients with genotype C, compared with 92% of all other genotypes.
    Loss of HBsAg was seen in 36% of patients with genotype A, 5% with genotype B, none with genotype C, and in 11% of those with genotype D.

Researchers speculated that HBV infections with genotypes C or D may remain highly active, "implying a risk for progressive liver damage."

HBV基因型可能决定感染的严重程度
越来越多的研究人员正在研究基因型乙肝病毒感染的进展起着什么样的影响。

近日，瑞典研究人员随后检测HBsAg，HBeAg阳性，ALT和病毒载量超过124未处理的成年人的9.2年。根据他们的报告发表在“临床病毒学杂志”：

    HBV DNA水平显着降低患者的基因型，A，B和D，而不是在C基因型
    HBeAg的损失被视为与C基因型患者的44％，比所有其他基因型有92％。
    HBsAg消失，患者基因型，5％，与B基因型，C基因型，基因型者的11％D. 36％

研究人员推测，C或D基因型乙肝病毒感染可能会保持高度活跃，“这意味着一个渐进的肝功能损害的风险。”

StephenW

First Tenofovir Trial for Adolescents Highly Successful
One of the first tenofovir clinical trials involving adolescents between the ages of 12 and 18 in the U.S. proved highly successful with 89% of those treated with tenofovir achieving undetectable viral load.

In this study, spearheaded by researchers at Seattle Children's Hospital, 52 adolescents took 300 mg daily of tenofovir for 72 weeks. Their results were compared with an untreated group of 54 teens who received placebo.

About 91% of patients were HBeAg-positive, and 85% had been previously treated with another antiviral or interferon.

Researchers reported in the journal Hepatology that 74% of tenofovir-treated patients achieved normal ALT levels, indicating no liver damage, compared to 32% in the placebo group.

Additionally, 89% of tenofovir-treated patients achieved viral load less than 400 copies/mL and 85% achieved a very low/undetectable viral load of 169 copies/mL. None of the control group achieved these low levels of HBV DNA.

"Tenofovir therapy in HBV-infected adolescents was well tolerated and highly effective at suppressing HBV DNA and normalizing ALT values in both (untreated) adolescents and those with prior exposure to HBV therapy," researchers wrote.

青少年非常成功的第一泰诺福韦审判
泰诺福韦涉及美国12和18岁之间的青少年首次临床试验证明非常成功的，89％的治疗者与泰诺福韦实现检测不到病毒负荷。

在这项研究中，在西雅图儿童医院的研究人员牵头，52青少年参加了72周泰诺福韦每天300毫克。 54青少年接受安慰剂的对照组相比，他们的研究结果。

约91％的患者HBeAg阳性，85％以前曾与其他抗病毒药物或干扰素治疗。

研究人员报告在杂志肝病，74％的替诺福韦治疗的患者取得了ALT水平正常，表示肝功能损害，32％，在安慰剂组相比。

此外，89％的替诺福韦治疗的患者达到病毒载量低于400拷贝/ ml和85％，取得了非常低/不到169拷贝/ ml的病毒载量。没有达到对照组的HBV DNA水平低。

“泰诺福韦治疗HBV感染的青少年被很好的耐受性和高度有效抑制乙型肝炎病毒DNA都（未处理）青少年和那些事先接触到乙肝治疗的ALT值正常化，”研究人员写道。

希望奇迹

比较几种药好像干扰并不是绝对占优？？

恰饭了某

StephenW 发表于 2012-6-3 01:18
New Hepatitis B Treatment Guidelines Released
The European Association for the Study of the Liver re ...

是不是说HBeAg阴性的只要病毒阳性就需要治疗???