B型肝炎治疗的HBeAg血清学转换的患者可能不会有持久的反应

StephenW

http://hivandhepatitis.com/hepatitis-b/hepatitis-b-topics/hbv-treatment/3832-hepatitis-b-patients-with-hbeag-seroconversion-on-treatment-may-not-have-durable-response
B型肝炎治疗的HBeAg血清学转换的患者可能不会有持久的反应
Hepatitis B Patients with HBeAg Seroconversion on Treatment May Not Have Durable Response

   
    Published on Tuesday, 23 October 2012 00:00
    Written by Liz Highleyman



People with chronic hepatitis B virus (HBV) who achieve hepatitis B "e" antigen (HBeAg) seroconversion when treated with nucleoside/nucleotide analogs are more likely to experience HBeAg seroreversion and HBV reactivation than those with natural clearance, according to a study described in the November 15, 2012, Journal of Infectious Diseases.

About 10% of people infected with HBV as adults and 90% of those infected at birth develop chronic hepatitis B, while the remainder experience spontaneous viral clearance without treatment. During natural clearance, loss of HBeAg in the blood and development of anti-HBe antibodies -- known as HBeAg seroconversion -- indicates resolution of active disease.

Several nucleoside and nucleotide analogs -- including lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), and tenofovir (Viread) -- are effective against HBV. Treatment response includes reduction of HBV DNA levels and in some people, HBeAg loss and seroconversion. It is not clear, however, if HBeAg seroconversion due to nucleoside/nucleotide therapy has a prognosis similar to that of spontaneous HBeAg seroconversion.

Tai-Chung Tseng from Buddhist Tzu Chi General Hospital in Taipei and colleagues looked at disease progression in 148 hepatitis B patients with nucleoside/nucleotide analog-induced HBeAg seroconversion (465 total person-years of follow-up), comparing them against a historical control group of 407 people with spontaneous HBeAg seroconversion (1653 total person-years of follow-up). None of the participants had liver cirrhosis.

Because spontaneous seroconverters were younger at the time of HBeAg seroconversion than those with nucleoside/nucleotide-induced seroconversion, the researchers compared the 2 cohorts according to their age at seroconversion.

Results

    Among people who achieved HBeAg seroconversion before age 30, those with nucleoside/nucleotide-induced seroconversion were significantly more likely to experience HBV seroreversion (reappearance of HBeAg) by year 2, with rates of 12% vs 3%, respectively.
    People with drug-induced seroconversion were also more likely to experience HBV reactivation, with a hazard ratio of 4.6, or nearly 5-fold higher risk.
    In a multivariate analysis, nucleoside/nucleotide-induced HBeAg seroconversion remained a risk factor for both endpoints in young seroconverters after controlling for other factors.

"[Nucleoside/nucleotide]-induced HBeAg seroconverters may not have durable response after stopping therapy," the study authors concluded. "For patients achieving HBeAg seroconversion before 30 years of age, the risk of HBeAg seroreversion and HBV reactivation is higher in [nucleoside/nucleotide]-induced seroconverters than spontaneous HBeAg seroconverters."

10/23/12

Reference

T-C Tseng, C-J Liu, T-H Su, J-H Kao, et al. Young Chronic Hepatitis B Patients With Nucleos(t)ide Analogue-induced Hepatitis B e Antigen Seroconversion Have a Higher Risk of HBV Reactivation. Journal of Infectious Diseases 206(10):1521-1531. November 15, 2012.

StephenW

B型肝炎治疗的HBeAg血清学转换的患者可能不会有持久的反应


    发表于2012年10月23号（星期二）00:00
    作者：利兹Highleyman的



慢性乙型肝炎病毒（HBV）的实现，与核苷/核苷酸类似物治疗乙肝的“e抗原（HBeAg）血清转换时人们更容易体验到HBeAg阳性的seroreversion和HBV再激活与自然间隙比，根据中描述的研究中华传染病杂志，2012年11月15日。

约10％的人感染乙肝病毒的成年人和90％的出生时感染者发展为慢性B型肝炎，而其余的经验自发清除病毒没有治疗。在自然间隙，HBeAg阳性，抗-HBe抗体的血液和发展的损失 - 被称为HBeAg血清学转换 - 显示分辨率为活动性疾病。

几种核苷和核苷酸类似物 - 包括拉米夫定（拉米HBV），阿德福韦（阿德福韦酯），恩替卡韦（博路定），替诺福韦（VIREAD的） - 有效的抗HBV。治疗反应包括减少一些人，HBV DNA水平和HBeAg消失和血清学转换。然而，目前尚不清楚，如果由于核苷/核苷酸治疗的HBeAg血清学转换有类似的自发性HBeAg血清转换的预后。

看着大钟曾从佛教慈济综合医院台北和他的同事们在疾病进展的148乙型肝炎的核苷/核苷酸类似物诱导的HBeAg血清学转换的患者（465人 - 年的随访），他们对历史对照比较组与自发性HBeAg血清转换的407人（1653年总人 - 年的随访）。的参与者有没有肝硬化。

由于自发的血清转化年轻的时候比核苷/核苷酸诱导血清学转换的HBeAg血清学转换，研究人员比较了两个世代，根据他们的年龄在血清学转换。

结果

    在实现HBeAg血清转换率在30岁之前，与核苷/核苷酸诱导血清学转换的的HBV seroreversion（再现HBeAg的）体验到第2年，12％和3％，分别显着更多的可能。
    药物引起的血清学转换的人也更容易体验到HBV再激活，危险比为4.6，或近5倍的风险较高。
    核苷/核苷酸诱导的HBeAg血清学转换在多变量分析中，年轻的血清转化为两个端点在控制了其他因素后，仍然是一个危险因素。

[核苷/核苷酸]引起的HBeAg血清转化可能不会有持久反应，在停止治疗后，“该研究的作者得出结论。 “对于实现HBeAg血清学转换的患者在30岁之前，风险较高的HBeAg的seroreversion和HBV激活[/核苷酸，核苷]引起的血清转化不是自发的HBeAg血清转化。”

12年10月23日

参考

曾T-C，C-J刘，苏T-H，J-H高，等。年轻核苷（酸）类似物诱导B型肝炎e抗原血清转换的慢性乙肝患者有较高的HBV再激活的风险。中国的传染病206（10）:1521-1531。 2012年11月15日。