乙肝在E抗原转换和巩固治疗后病毒高几率复发

肝胆速递

http://www.ncbi.nlm.nih.gov/pubmed/22941429##
J Clin Gastroenterol. 2012 Aug 30. [Epub ahead of print]

High Frequency of Recurrent Viremia After Hepatitis B e Antigen Seroconversion and Consolidation Therapy.乙肝在E抗原转换和巩固治疗后病毒高几率复发

肝胆速递：文章提示，E抗原转换并不是一个好的停止治疗的指标，即使在巩固治疗后，仍然有相当大风险复发

Chaung KT, Ha NB, Trinh HN, Garcia RT, Nguyen HA, Nguyen KK, Garcia G, Ahmed A, Keeffe EB, Nguyen MH.
Source

*Pacific Health Foundation ‡San Jose Gastroenterology, San Jose †Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA.
Abstract
BACKGROUND:

The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hepatitis B is HBeAg seroconversion; however, data on the durability of response are inconsistent.
GOALS:

Our goal was to investigate the rate of recurrent viremia after HBeAg seroconversion and subsequent discontinuation of therapy.
METHODS:

We retrospectively studied 88 consecutive Asian American patients who achieved HBeAg seroconversion [loss of HBeAg and development of antibody to HBeAg (anti-HBe)] among 458 HBeAg-positive patients who received oral antiviral therapy at 3 US clinics between March 1998 and November 2010. Recurrent viremia was defined as reappearance of detectable serum hepatitis B virus DNA (>100 IU/mL) on 2 consecutive laboratory tests from previously undetectable levels.
RESULTS:

Antiviral medications used at the time of HBeAg seroconversion included: lamivudine (23%), adefovir (34%), entecavir (36%), tenofovir (4%), and combination therapy (3%). Antiviral therapy was continued after HBeAg seroconversion in 49 patients (group I) and discontinued in the other 39 patients after consolidation therapy [median=12 months (range, 1 to 55 mo)] (group II). No patients in group I experienced recurrent viremia, whereas 90% in group II did. Elevated alanine aminotransferase also occurred in 38% of group II patients [median peak alanine aminotransferase 249 IU/mL (range, 93 to 1070 IU/mL)].
CONCLUSIONS:

Despite consolidation therapy, almost all patients who discontinued therapy after achieving HBeAg seroconversion and complete viral suppression experienced recurrent viremia, and close to half also experienced biochemical flares. HBeAg seroconversion does not seem to be a durable treatment endpoint for many patients, and they should be monitored carefully for virologic relapse and biochemical flares if antiviral therapy is withdrawn.

肝胆速递

临床胃肠病学杂志。 2012年8月30日。 [EPUB的提前打印]
高频B型肝炎e抗原血清学转换和巩固治疗后复发性病毒血症。
Chaung KT，哈NB，郑氏HN，加西亚RT，阮HA，阮KK，加西亚ĝ，艾哈迈德A，KEEFFE EB，阮MH。
源

太平洋健康基金会：‡圣何塞胃肠病学，胃肠病学和肝病学杂志圣何塞†科，斯坦福大学医学中心，斯坦福大学，加利福尼亚。
抽象
背景：

主要的治疗终点为B型肝炎e抗原（HBeAg）阳性的慢性乙型肝炎HBeAg血清学转换，但数据的耐用性反应是不一致的。
目标：

我们的目标是HBeAg血清转换和随后停止治疗后复发的病毒血症率调查。
方法：

我们回顾性研究了88个连续的亚洲裔患者实现HBeAg血清学转换[1998年3月至2010年11月在美国诊所接受口服抗病毒治疗的458例HBeAg阳性患者中损失的e抗原HBeAg和发展抗体（抗-HBe）。复发性病毒血症再现，检测血清乙肝病毒DNA（> 100 IU / mL）的定义为连续2次实验室测试之前检测不到的水平。
结果：

HBeAg血清学转换的时候使用的抗病毒药物包括：拉米夫定（23％），阿德福韦酯（34％）（36％），恩替卡韦，替诺福韦（4％），而联合治疗组（3％）。继续抗病毒治疗后HBeAg血清学转换49例（I组）和终止后巩固治疗39例[中位数为12个月（范围，1至55月）]（II组）。没有病人组中，我经历了经常性的病毒血症，而在第二组的90％。第二组患者中，38％的谷丙转氨酶升高也时有发生[中位数峰值谷丙转氨酶249 IU / mL（范围93〜1070 IU / mL）的。
结论：

尽管巩固治疗，几乎所有的病人停止治疗后，实现HBeAg血清学转换和完整的病毒抑制的经常性的病毒血症，接近一半也有经验的生化耀斑。 HBeAg血清学转换似乎并不为许多患者是一个持久的治疗终点，他们应小心监测抗病毒治疗的病毒学复发和生化耀斑被撤回。

咬牙硬挺

核苷不能停，也就是战友们常说的上贼船