AASLD 2012 Liver Meeting
HBV Coverage by Christine M. Kukka Hepatitis B experts from around the world, meeting at the 62nd annual American Association for the Study of Liver Diseases conference, shared the latest in hepatitis B treatment and research. Here are some of the highlights. B型肝炎举行的第62届美国肝病研究会议，来自世界各地的专家，分享最新的B型肝炎的治疗和研究。这里有一些亮点。
New Treatments
新的治疗方法
Improving Patient Care
改善病人护理
Treating Children and Teens
治疗儿童和青少年
Combination Interferon and Antiviral Treatment
结合干扰素和抗病毒治疗
When can patients stop taking antivirals?
何时病人停止服用抗病毒药物？
Side Effects from Antivirals
从抗病毒药物的副作用
Entecavir vs. Tenofovir
恩替卡韦 对 替诺福韦
Liver Cancer
肝癌
HBV Transmission to Newborns
乙肝病毒传播给新生儿
Preventing Hepatitis B Reactivation in Cancer Patients
在癌症患者预防B型肝炎恢复
New Treatments 新的治疗方法 Second-generation REP 9AC' clears HBsAg within weeks: Last year, researchers surprised the hepatitis B world when they debuted a new drug—REP 9AC—that stopped hepatitis B virus (HBV)-infected liver cells from manufacturing hepatitis B surface antigen (HBsAg) within weeks in more than half of patients treated. HBsAg is crucial for viral replication. This year, a second-generation version called REP 9AC’ (nucleic acid-based amphipathic polymer—NAP) was combined with either pegylated interferon or Zadaxin (both drugs stimulate the immune system to fight infection) to assess the combined drugs' effectiveness. The 12 patients in the study were HBsAg-positive with high viral loads (with HBV DNA exceeding 1 million copies/ml). Ten of 12 patients cleared HBsAg and developed surface antibodies after 20 to 30 weeks of treatment. Clearance of HBsAg reduced HBV DNA on average by between 250,000 to 1 million copies/ml. "REP 9AC’ can rapidly and effectively clear HBsAg from the serum of infected patients and allow the restoration of an effective immune response, as evidenced by substantial reductions in serum HBV DNA," researchers wrote. Combination treatment with immune stimulants may leads to, "a permanent control of HBV infection." - 424. REP 9AC’: A second generation HBsAg release inhibitor with improved tolerability
- 第二代REP 9AC在几个星期内清除乙肝表面抗原：去年，研究人员惊讶的B型肝炎的世界时，他们首次推出一个新的药物REP 9AC停止乙型肝炎病毒（HBV）感染的肝细胞制造B型肝炎表面抗原（HBsAg周治疗的患者中有一半以上）内。 HBsAg是病毒复制的关键因素。
今年，第二代版本称为REP 9AC“（基于核酸的两亲性高分子NAP）的结合，无论是聚乙二醇干扰素或日达仙（这两种药物刺激免疫系统来对抗感染），以评估合并药物的有效性。
与高病毒载量（HBV DNA超过100万拷贝/ ml），12例患者在研究中HBsAg阳性。 12例患者中清除10个20至30周的治疗后，乙肝表面抗原和表面抗体发达。清除乙肝表面抗原降低HBV DNA平均25万至100万拷贝/ ml。
“REP 9AC可以迅速和有效地清除乙肝表面抗原感染患者的血清中，并允许恢复有效的免疫反应，大幅降低血清中HBV DNA，”研究人员写道。免疫刺激剂的联合治疗可能会导致，“永久控制乙肝病毒感染。”
424。 REP 9AC：第二代改进的耐受性乙肝表面抗原缓释剂
New interferon causes fewer flu-like symptoms. A 24-week study comparing standard pegylated interferon with a new interferon, called pegylated interferon-Lambda, found Lambda was more potent and caused fewer side effects. In this global study, 80 patients were treated with lambda and 83 with standard interferon. Most were male, Asian, with genotypes B and C and elevated ALT levels and high viral loads. Lambda-treated patients had significantly greater reduction in HBsAg levels and HBV DNA. HBeAg losses were similar in both groups. Two patients (both Lambda recipients) cleared HBsAg. Patients treated with conventional interferon had higher rates of fever, hair loss, headache, muscle pain (76% vs 8%). These results match similar findings in hepatitis C patients treated with Lambda. - LB-14. Peginterferon Lambda, a New Potential Therapeutic Option for the Treatment of Chronic Hepatitis B: A Phase 2B Comparison with Peginterferon Alfa in Patients with HBeAg-Positive Disease
新的干扰素较少引起类似流感的症状。 A 24周的研究中，发现一个新的干扰素，聚乙二醇化干扰素-λ比较标准的聚乙二醇干扰素拉姆达是更有效和造成的副作用较少。
在这个全球性的研究中，80例患者治疗与标准干扰素λ和83。大多数为男性，亚洲，基因型B和C，ALT水平升高，高病毒载量。拉姆达治疗的患者HBsAg水平与HBV DNA显着减少。 HBeAg的损失在两组相似。两名病人（包括的拉姆达收件人）HBsAg清除。
与传统的干扰素治疗的患者率较高的发热，脱发，头痛，肌肉疼痛（76％比8％）。这些结果符合了类似的结果，在C型肝炎患者的lambda。
LB-14。聚乙二醇干扰素λ，一个潜在的新的治疗方法治疗慢性乙型肝炎的患者HBeAg阳性患者与聚乙二醇干扰素α2b期比较
Improving Patient Care
改善病人护理
Primary care providers fail to properly care for hepatitis B patients: A study into the quality of care that 12,016 hepatitis B patients enrolled in a Northern California Kaiser Permanente Medical Care Program received between July 2009 and December 2010 found that while most specialists ordered the screenings required to monitor these patients' health properly, but primary care providers frequently failed to order lab test and liver cancer screenings recommended by medical guidelines. - 311. Chronic Hepatitis B Management in a California Integrated Care Population
初级保健提供者未能妥善照顾B型肝炎患者：12,016乙肝患者的护理质量，就读于北加州Kaiser Permanente的医疗保健计划2009年7月和2010年12月之间收到的一项研究，发现，虽然大多数专家订购所需要的放映监控这些病人的健康状况正常，但经常初级保健提供者没有下令实验室测试和肝癌筛检的医疗指引建议。
311。在加州综合护理人口的慢性乙型肝炎管理
New education tool helps patients learn about hepatitis B: Studies show the need to educate patients about hepatitis B in ways that make the complex infection understandable, especially if they have limited English proficiency (in the U.S.) or have limited knowledge about infection. One study found that having a health educator of a shared ethnicity was effective. In another one study, to simplify the complex stages of chronic hepatitis B infection, Australian physicians tried using an illustration of a bear, along with different terminology, to describe inactive, active and other phases of HBV infection. They tried replacing current infection descriptors such as silent, damaging, controlled, escape and clear (for HBsAg loss) by using descriptions of a bear—hibernating, attacking, in a cage, breaking out of cage, and dead—to illustrate the infection. Knowledge about hepatitis B increased among 30 patients who were given the new bear illustrations. Overall, 83% of patients reported the "bear" references were more effective in educating them about the phases of infection. - 334. The Hepatitis B Bear: Novel patient orientated information enhances patient understanding of the phases of Hepatitis B
- 431.Disease and Treatment Perceptions Among Asian Americans Diagnosed with Chronic Hepatitis B Infection
新的教育工具，帮助患者了解B型肝炎：研究表明，乙肝患者需要教育的方式，使复杂的感染可以理解的，特别是如果他们英语能力有限（在美国），或有感染知识有限。一项研究发现，有一个健康教育的共享种族是有效的。在另一项研究中，慢性B型肝炎感染，简化了复杂的阶段，澳大利亚医生试图使用说明的熊，以及不同的术语，来描述无效的，积极的和其他阶段的HBV感染。
他们试图感染的描述，如沉默不语，破坏性，控制，逃生和明确的（HBsAg消失）取代目前使用的熊冬眠的描述，攻击，关在笼子里，笼，死说明感染。
B型肝炎的知识增加30例中，谁被赋予新的熊插图。总体而言，83％的患者报告“熊市”的引用更有效地教育他们有关的感染阶段。
334。 B型肝炎熊：一种新患者为导向信息，提高的阶段B型肝炎患者的理解
431。美国在亚洲的疾病和治疗的认知诊断为慢性B型肝炎病毒感染
Normal ALT levels can be misleading: A U.S. study followed 40 Asian-American patients who initially had normal alanine transaminase (ALT) levels—showing no liver damage—after liver biopsies. Their ALT levels were tested every six weeks and 40% were found to have spikes in their ALT levels that indicated liver damage, underscoring the need to regularly test even patients with normal ALT levels and to treat as needed. Another study found similar rates of inflammation and fibrosis among HBeAg-positive patients even if their ALT levels were normal or slightly elevated. Just under one-third of these patients with normal or moderately-elevated ALTs were found to have fibrosis. Both groups had similar HBV DNA levels. - 457. Clinical Course and Outcomes of Asian Patients with Chronic Hepatitis B (CHB), Normal ALT, and Live Biopsy (LB) Report of Mild Liver Injury
- 354. Significant fibrosis in liver biopsies from HBeAg-positive chronic hepatitis B patients with low ALT
正常的ALT水平可能会产生误导：美国的一个研究追踪了40个亚洲和美国的病人最初有正常的谷丙转氨酶（ALT）水平，显示无肝损伤后肝活检。他们的ALT水平测试每六个星期，40％被发现在他们的ALT水平达到峰值，表明肝功能损害，强调有必要，即使ALT水平正常的患者要定期检测和治疗需要。
另一项研究发现，即使他们的ALT水平正常或轻度升高的HBeAg阳性患者中的炎症和纤维化的发生率相似。只有不到三分之一的这些患者，正常或轻度升高的低价竞标中发现有纤维化。这两个群体也有类似的HBV DNA水平。
457。亚洲慢性乙型肝炎（CHB），转氨酶正常，以及现场活检（LB）报告轻度肝损伤患者的临床过程和结果
354。低ALT的HBeAg阳性慢性乙型肝炎患者的肝活检显着纤维化
Treating Children and Teens
治疗儿童和青少年 Pegylated interferon and tenofovir highly effective: Two studies found that two treatments—to date approved only for adults—appear highly effective in children. Thirty-one children, ages 2-16, treated with a weekly dose of pegylated interferon for up to 104 weeks, achieved undetectable HBV DNA. Additionally: - 41.2% cleared HBsAg and 35.3% developed surface antibodies and cleared the infection.
- 41.2% of older children and 47.1% of younger children lost HBeAg and developed "e" antibodies. None of the children experienced any relapses up to 12 weeks after treatment ended.
A study into the effectiveness of the antiviral tenofovir (Viread) in adolescents, compared to a placebo-treated group, showed that after 72 weeks of treatment, 96% of patients who had high ALTs achieved undetectable HBV DNA, 75% had normal ALTs, and 31% lost HBeAg. Among those with moderately-elevated ALTs at the start of the study, 79% achieved undetectable HBV DNA and 71% had normal ALT levels—showing the antiviral worked well in both groups. - 387. The efficacy and safety of peginterferon treatment in children with chronic hepatitis B
- 371. Tenofovir treatment results in high rates of virologic suppression and ALT response in adolescents with chronic active hepatitis B regardless of baseline ALT levels
聚乙二醇化干扰素和替诺福韦高效：两项研究发现，两种治疗方法，迄今只核准用于成人在孩子出现非常有效的。三十一岁的孩子，2月16日，长达104周，每周剂量的聚乙二醇干扰素治疗，HBV DNA检测不到。此外：
41.2％的HBsAg清除和35.3％的表面抗体，清除了感染。
年龄较大的儿童和41.2％，47.1％，年幼的孩子失去了HBeAg和开发的“E”的抗体。孩子没有经历过任何复发治疗结束后至12周。
研究的抗病毒药物替诺福韦（VIREAD的）青少年的成效，到安慰剂组相比，结果显示，治疗72周后，96％的患者有高低价竞标的HBV DNA检测不到，75％有正常的低价竞标， 31％失去了HBeAg的。在那些与中等低价竞标的在研究开始升高，79％的HBV DNA检测不到，71％ALT水平正常，抗病毒药物在这两个群体。
387。聚乙二醇干扰素治疗慢性乙型肝炎的儿童的疗效和安全性
371。在青少年慢性活动性乙型肝炎的病毒抑制和ALT响应的高利率无论基线ALT水平的替诺福韦治疗结果
Combination Interferon and Antiviral Treatment 结合干扰素和抗病毒治疗 Pegylated interferon plus an antiviral show promise: Several studies examined whether sequential treatment with interferon and antiviral could result in higher rates of viral clearance. One study administered pegylated interferon to patients who had already achieved undetectable HBV DNA through antiviral treatment to see if the 48 weeks of interferon would strengthen the patients' immune systems enough to clear the infection. Half of 16 patients receiving the combination treatment lost HBsAg (all were HBeAg-negative when starting treatment), and five of them ultimately developed surface antibodies and cleared the infection. Two of five HBeAg-positive patients lost HBeAg during combination treatment. Another study found 18% of patients treated with entecavir and interferon lost HBeAg, compared to 8% who received just the antiviral. Slightly more patients treated with both drugs achieved undetectable HBV DNA and HBsAg loss. One of 84 patients receiving both entecavir and interferon lost HBsAg. Adding 24 weeks of interferon to ongoing antiviral treatment, "increases HBsAg decline and clearance of HBeAg and may therefore improve the chances of finite treatment in HBeAg-positive patients..." researchers wrote. - 430. Improvement of HBsAg Loss by additional PEG IFN in Nucleosides Analogs treated Chronic Hepatitis B Patients
- 19. Adding peginterferon alfa-2a to entecavir increases HBsAg decline and HBeAg clearance - first results from a global randomized trial (ARES study)
- 485.Quasispecies analysis of HBV strains isolated from chronic hepatitis B patients treated with Peg-interferon+Tenofovir therapy
聚乙二醇干扰素联合抗病毒药物有希望：一些研究审查是否序贯治疗干扰素和抗病毒药物可能会导致病毒清除率较高。
一项研究管理的聚乙二醇干扰素已经通过抗病毒治疗HBV DNA检测不到，看看48周的干扰素，增强患者的免疫系统清除感染的病人。
接受联合治疗的16例患者失去了一半的乙型肝炎表面抗原（HBsAg）（均为HBeAg阴性开始治疗时），他们最终研制出表面抗体五，清除了感染。五分之二的HBeAg阳性患者失去了在联合治疗HBeAg阳性。
另一项研究发现，18％的恩替卡韦和干扰素治疗的患者失去了大三阳，相比8％的人收到的抗病毒。这两种药物治疗更多的患者检测不到HBV DNA和HBsAg消失。其中的84例患者接受恩替卡韦和干扰素失去了乙肝表面抗原。新增24个星期干扰素进行抗病毒治疗，“增加了乙肝表面抗原HBeAg的下降和清除，因此可能提高的机会有限HBeAg阳性患者的治疗......”研究人员写道。
430。额外的PEG IFN HBsAg消失在核苷类似物治疗慢性乙型肝炎患者的改进
19。添加聚乙二醇干扰素α-2a恩替卡韦下降，增加乙肝表面抗原HBeAg清除 - 从一个全球性的随机对照试验（ARES研究的第一个成果）
485。准种分析与聚乙二醇干扰素+替诺福韦治疗慢性乙型肝炎患者的HBV株
When can patients stop taking antivirals?
何时病人停止服用抗病毒药物？ After clearing HBsAg: Several studies explored when it was safe for patients to stop taking antivirals. Physicians had hoped they could wean patients off antivirals after they lost HBeAg and/or had several months of undetectable HBV DNA and healthy ALT levels. Unfortunately, those endpoints have not been successful and many of these patients have experienced resurgences in infection after stopping treatment. During this conference, researchers reported that once patients achieve undetectable viral load and lose HBsAg, they may be able to stop antiviral treatment. One study followed 58 patients (47% HBeAg-positive at start of treatment) who cleared HBsAg after nearly four years of lamivudine or entecavir treatment. Twenty months after treatment stopped, two redeveloped HBsAg, but their HBV DNA remained undetectable. Twelve of the 58 developed detectable HBV DNA, but none ever had high viral loads or had "flares" in their ALT. "HBsAg seroclearance following (antiviral) therapy is rare, but durable in most patients ... after treatment discontinuation," they wrote. "Therefore, HBsAg seroclearance would be an ideal treatment endpoint during (antiviral) therapy." Other studies followed patients for one year who stopped antivirals after 18 months of undetectable HBV DNA—but not undetectable HBsAg. A resurgence in viral load developed in 22 (48.9%) and 33 (73.3%) patients at 6 months and 12 months after therapy. Other studies underscored the risk posed by prematurely stopping antivirals, especially in HBeAg-negative patients, even if they have had undetectable HBV DNA for extended periods. - 313. Is HBsAg seroclearance following nucleoside analogue therapy durable in patients with chronic hepatitis B?
- 362. Nucleos(t)ide analogues can be safely discontinued in chronic hepatitis B patients achieving HBsAg seroclearance
- 336. Durability after discontinuation of nucleos(t)ide therapy in hepatitis e antigen negative chronic hepatitis B patients
- 447. High relapse rates in HBeAg negative chronic hepatitis B patients after discontinuation of nucleos(t)ide analogues
在清除乙肝表面抗原：一些研究探索时，它是安全的患者停止服用抗病毒药物。医生希望他们能够戒掉患者关抗病毒药物后，他们失去了HBeAg和/或几个月的检测不到HBV DNA和健康的ALT水平。不幸的是，这些端点没有成功，这些患者中有许多经验丰富的大洋洲，在停止治疗后感染。
在这次会议上，研究人员报告说，一旦患者达到检测不到的病毒载量和失去乙肝表面抗原，他们可能会停止抗病毒治疗。一个研究追踪了58例患者（47％在开始治疗HBeAg阳性）经过近四年的拉米夫定或恩替卡韦治疗HBsAg清除。治疗20个月后停了下来，两个重建乙肝表面抗原，但其HBV DNA仍然检测不到。十二的58个发达检测到HBV DNA，但没有以往任何时候都具有较高的病毒载量，或有“火炬”在他们的ALT。 “乙肝表面抗原转阴以下（抗病毒）治疗是罕见的，但耐用，大多数患者治疗后停药，”他们写道。 “因此，乙肝表面抗原转阴，是一种理想的治疗终点（抗病毒）治疗过程中。”
其他的研究随后一年，18个月后检测不到HBV DNA，但没有检测不到乙肝表面抗原停止抗病毒药物的患者。中有22例（48.9％）和33例（73.3％），6个月和12个月的治疗后，病毒载量的复苏。其他的研究强调，过早停止抗病毒药物，特别是在HBeAg阴性患者，即使他们已长时间检测不到HBV DNA所带来的风险。
313。乙肝表面抗原转阴后，在慢性乙型肝炎患者的核苷类似物治疗耐用的吗？
362。核苷（酸）类似物可以安全地停止在达到乙肝表面抗原转阴的慢性乙型肝炎患者
336。核苷（酸）IDE治疗肝炎e抗原阴性的慢性乙肝患者停药后的耐久性
447。 HBeAg阴性慢性乙型肝炎的核苷（酸）类似物停药后患者的高复发率
Side Effects from Antivirals
从抗病毒药物的副作用
As more patients are treated for longer periods with antivirals, doctors are identifying side effects that include mild kidney damage and bone density loss. 随着越来越多的患者使用抗病毒药物治疗的时间较长，医生们确定的副作用，包括轻度肾损害及骨质密度的损失。
Impact on kidneys: One study followed 528 patients (180 taking adefovir (Hepsera), 128 tenofovir, and 220 entecavir (Baraclude) for three to five years. They found adefovir-treated patients had higher creatinine levels in their bloodstream, indicating reduced kidney function, compared to tenofovir- and entecavir-treated patients after one year. Eleven adefovir patients had to change to another antiviral due to kidney impairment. Another study of 124 patients taking either entecavir or tenofovir found only mild impact on kidney function, and another study found that patients who had kidney problems with adefovir regained normal kidney function after switching to tenofovir. However, a French study found that HBV-infected patients already had reduced kidney function even before starting antiviral treatment. They found kidney abnormalities in one-third of patients screened, and chronic kidney disease in one-quarter of HBsAg-positive patients, regardless of disease state. They recommended that all patients have renal evaluations before and during antiviral treatment in order to monitor kidney health and adjust antiviral dosing as needed. 对肾脏的影响：一个研究追踪了528例（180服用阿德福韦（阿德福韦酯），128个替诺福韦和220恩替卡韦（博路定）的三到五年内，他们发现阿德福韦治疗的患者有较高的肌酐水平在他们的血液，肾功能降低替诺福韦和恩替卡韦治疗的患者相比，11个阿德福韦的患者一年后切换到另一种抗病毒药由于肾脏损害。
另一项研究发现124例，无论是恩替卡韦或替诺福韦只有轻微的肾功能的影响，另一项研究发现，有肾脏问题与阿德福韦的患者肾功能恢复正常后切换到替诺福韦。
然而，法国的一项研究发现，HBV感染的患者已经肾功能减退，甚至在开始抗病毒治疗。他们发现，在一季度的HBsAg阳性患者中有三分之一的患者筛选，慢性肾脏病，肾功能异常疾病状态无关。他们建议，所有的患者有肾功能评价抗病毒治疗之前和期间，以监测肾脏健康，并根据需要调整抗病毒药物的剂量。 Impact on bone density: Researchers measured bone mineral density (BMD) loss in patients treated with tenofovir for 12 months or more. They found BMD loss in 43% of the patients. - 385. Renal Abnormality in Chronic Hepatitis B Patients Treated with Oral Nucleos(t)ide Analogs
- 443.Do tenofovir and entecavir affect renal function in patients with chronic hepatitis B (CHB)? A two-year observational study from a single Australian centre
- 921. HARPE study: prevalence of renal abnormalities in chronic HBV infection
- 406. Switching to tenofovir is safe in most chronic hepatitis B patients with a reduced glomerular filtration rate due to previous exposure to adefovir dipivoxil
- 22.FRAX score in the assessment of Bone Mineral Density changes in Tenofovir treated Chronic Hepatitis B patients: comparison with bone biochemistry and DEXA scanning
对骨密度的影响：研究人员测量与替诺福韦治疗的患者为12个月或以上的骨矿物质密度（BMD）的损失。他们发现，43％的患者的骨质流失。
385。口服核苷（酸）类似物治疗慢性乙型肝炎患者的肾功能异常
443。替诺福韦和恩替卡韦影响慢性乙型肝炎（CHB）患者的肾功能？从一个单一的澳大利亚中锋一项为期两年的观测研究
921。帕斯研究：慢性HBV感染的肾功能异常的患病率
406。切换到替诺福韦是安全的在大多数慢性B型肝炎患者由于先前曝光的阿德福韦酯与肾小球滤过率减少
22.FRAX替诺福韦治疗慢性乙型肝炎患者的骨密度变化的评估得分：比较与骨生化和DEXA扫描
Tenofovir Continues to be highly effective, even with multi-drug resistance: Several studies, including a six-year, multinational study following 466 patients, found this antiviral to be highly effective in suppressing HBV DNA, with no signs of tenofovir-resistance developing. The long-term study also found low rates of kidney problems and no evidence of "clinically-relevant" bone loss. Even when drug resistance to both lamivudine (Epivir-HBV) and adefovir have developed, one study found four years of tenofovir treatment continued to keep HBV DNA at low or undetectable levels, with no signs of tenofovir-resistance. - 374. Six years of treatment with tenofovir DF for chronic hepatitis B virus infection is safe and well tolerated and associated with sustained virological, biochemical and serological responses with no detectable resistance
- 361. Tenofovir rescue therapy achieves long-term suppression of HBV replication in patients with multi-drug resistant HBV: 4-year follow-up of the TDF109 cohort
替诺福韦继续是非常有效的，即使与多药耐药性：一些研究，包括6年，跨国公司的466例患者的研究，发现这种抗病毒是非常有效的抑制HBV DNA，与替诺福韦性的发展没有任何迹象。长期的研究还发现，低利率的肾脏问题，没有证据表明，“临床相关的骨质流失。
即使拉米夫定（拉米HBV）和阿德福韦的耐药性发展，一项研究发现替诺福韦治疗四年继续保持在较低或检测不到的水平，HBV DNA与替诺福韦性没有任何迹象显示。
374。六十年与替诺福韦DF治疗慢性乙型肝炎病毒感染的治疗是安全的，耐受性好，与持续病毒学，生化和血清学反应与无检测电阻
361。替诺福韦抢救治疗达到长期抑制HBV复制与多药耐药HBV患者4年的随访TDF109队列
Entecavir Research shows continued effectiveness: Studies find this antiviral to continue to be highly effective, with 49.88% achieving normal ALTs after six months, 54.42% at one year and 57.97% after four years. HBeAg seroconversion rates were 10.26% after six months, 16.54% after one year and 24.39% after four years. Usage was also found to decrease liver cancer risk due to lowered viral load, and other studies showed the drug was effective in reducing recurrence of liver cancer and also lesions on the liver. One study showed a small rate of antiviral resistance in entecavir in patients who failed to achieve undetectable viral load after 48 weeks. Three years into treatment, 1.6% of those who initially responded had a resurgence in viral load, and 5.9% of those who did not completely respond in the first 48 weeks of treatment had viral breakthrough. - 351. Entecavir monotherapy in NA naive chronic hepatitis B and cirrhosis patients: A retrospective and prospective cohort study over 4 years of treatment
- 367.Entecavir treatment significantly reduces the risk of hepatocellular carcinoma recurrence in patients with chronic hepatitis B
- 376. Long-term efficacy of continuous entecavir 0.5 mg monotherapy in naïve chronic hepatitis B patients with partial virological response at week 48
恩替卡韦研究表明，持续的效果：研究发现这种抗病毒继续是非常有效的，49.88％，半年后达到正常的低价竞标，四年后，在一年的54.42％和57.97％。 HBeAg血清转换率分别为10.26％，半年后，一年后的16.54％和24.39％，四年后。
用途还发现，由于降低病毒载量降低肝癌的风险，和其他的研究表明，该药物有效地降低肝癌复发，也对肝脏的病变。
一项研究显示恩替卡韦小的抗病毒药物耐药率未能达到48周后检测不到病毒载量的患者。治疗三年后，1.6％的人最初的反应有死灰复燃的病毒载量，和那些谁没有完全响应在第48周的治疗，病毒突破5.9％。
351。 NA天真的慢性乙型肝炎和肝硬化患者恩替卡韦单药治疗：超过4年的治疗，回顾性和前瞻性队列研究
367.Entecavir慢性乙型肝炎患者，治疗显着降低肝癌术后复发的风险
376。在天真的慢性乙型肝炎患者在48周的部分病毒学应答的持续恩替卡韦0.5 mg单药治疗的长期疗效
Entecavir vs. Tenofovir
恩替卡韦 v 替诺福韦
Is one better than the other? Real world treatment data shows there is little difference in the effectiveness of these two antivirals, which are currently recommended as the top two antivirals for treating hepatitis B. One study compared two years of data from 130 entecavir-treated patients and 121 tenofovir-treated patients—both groups had similar levels of infection and liver damage, and about one-third in each group were HBeAg-positive. There was no significant difference in HBV DNA levels after one year of treatment, however, two years into treatment, more entecavir patients had lost HBeAg than those treated with tenofovir. But even those rates began evening out into the third year of treatment. In patients with cirrhosis, entecavir and tenofovir also appeared to be equally effective. - 337. Entecavair [sic]versus tenofovir in treatment-naïve chronic Hepatitis B patients: Real-world data from the realist* study
- 390. Long-term clinical outcomes of entecavir and tenofovir in hepatitis B cirrhosis
是一个比其他更好吗？现实世界中的治疗数据显示，这两种抗病毒药物的效果几乎没有什么差别，这是目前推荐的两种抗病毒药物治疗B型肝炎
一项研究比较了两年的数据从130恩替卡韦治疗的患者，替诺福韦治疗的患者和121这两个群体也有类似的感染和肝功能损害，大约有三分之一在各组的HBeAg阳性。
一年的治疗后，HBV DNA水平并没有显着的差异，但是，在治疗2年后，越来越多的恩替卡韦治疗HBeAg阳性患者已经失去了与替诺福韦治疗的。但即使是那些价格开始晚上的治疗进入第三年。
在肝硬化患者中，恩替卡韦和替诺福韦也出现同样有效。
337。 Entecavair [原文]与替诺福韦治疗初治慢性乙肝患者：真实世界的数据，从现实主义的研究
390。长期的临床结果在B型肝炎肝硬化，恩替卡韦和替诺福韦
Liver Cancer
肝癌 Antiviral treatment reduces liver cancer risk: A U.S. study following 2,463 patients found that those who were treated with antivirals were at lower risk of liver cancer. The incidence of liver cancer was 3.3 cases per 1,000 person-years among those treated with antivirals, and 5.3 cases per 1,000 person years among those who were not treated. Other risk factors for liver cancer included older age and male gender. - 318.Hepatitis B therapy and incidence of hepatocellular carcinoma in a U.S. population
抗病毒治疗可以减少肝癌的风险：美国的一项研究发现，那些谁使用抗病毒药物治疗肝癌的风险较低的2,463例患者。肝癌的发病率是3.3每1000人年在使用抗病毒药物治疗，1000人，在那些不及时治疗和5.3％。肝癌的其他危险因素包括年龄和性别为男性。
318。 B型肝炎治疗肝癌的发病率在美国人口
Genotype D appears to carry higher risk of liver cancer, despite antiviral treatment: Even prolonged antiviral treatment does not appear to lessen liver cancer risk in older adults with hepatitis B genotype or strain D. Researchers in Italy followed 235 patients with HBV genotype D who had been treated with antivirals and discovered that 32 (13.2%) developed liver cancer over a seven-year period. Liver cancer occurrence was higher in these genotype D patients who had cirrhosis, were age 60 or older, and who had not completely responded to antiviral treatment. - 21.Impact of liver fibrosis in development of hepatocellular carcinoma in HBeAg negative genotype D patients with chronic hepatitis B treated with nucleos(t)ide analogues.
D型进行抗病毒治疗肝癌的风险较高，但不出现甚至长期抗病毒治疗，以减轻肝脏中老年人患癌症的风险B型肝炎基因型或应变D.在意大利的研究人员随后235例HBV基因型D有使用抗病毒药物治疗，并发现32例（13.2％），肝癌超过7年的时间内。肝癌的发生是在这些D型有肝硬化的患者，分别为60岁或以上，抗病毒治疗还没有完全回应。
21。 HBeAg阴性D基因型患者核苷（酸）类似物治疗慢性乙型肝炎肝纤维化的肝细胞性肝癌的发展的影响。
Past lamivudine use may raise liver cancer risk: In a unique study, researchers compared liver cancer risk in patients who had been successfully treated with antivirals. Despite achieving low viral loads, a small group of older patients developed liver cancer—many of whom had been treated with lamivudine. "The association with lamivudine exposure raises the possibility of drug-induced mutations associated with an increased risk of liver cancer development - this possibility is currently under investigation," they wrote. - 332.Hepatocellular carcinoma risk in chronic hepatitis B patients achieving viral suppression with antiviral therapy.
过去拉米夫定的使用可能会引发肝癌的危险：在一个独特的研究中，研究人员已经成功地使用抗病毒药物治疗的患者相比，肝癌风险。尽管已经实现低病毒载量的老年患者肝癌许多人开发的，一小群与拉米夫定治疗。 “拉米夫定曝光与提高药物引起的基因突变与肝癌发展的危险性增加的可能性 - 这种可能性目前正在调查中，”他们写道。
332.Hepatocellular癌的风险，实现抑制病毒的抗病毒治疗的慢性乙肝患者。
HBV Transmission to Newborns 乙肝病毒传播给新生儿 Amniocentesis increases HBV risk to newborns: A joint U.S.-Chinese study found that performing amniocentesis on HBV-infected pregnant women increased the risk that their infants would become infected—especially if the women had high HBV DNA levels. - 904. Risk of hepatitis B virus (HBV) vertical transmission after amniocentesis in mothers with chronic hepatitis B
羊膜穿刺术，增加了乙肝病毒给新生儿的风险：美国与中国的联合研究发现，HBV感染的孕妇进行羊膜穿刺术的风险增加，他们的婴儿会被感染，尤其是如果妇女有较高的HBV DNA水平。
904。慢性B型肝炎的母亲羊膜穿刺后的B型肝炎病毒（HBV）母婴垂直传播的危险
Preventing Hepatitis B Reactivation in Cancer Patients 在癌症患者预防B型肝炎恢复 Experts: Don't use lamivudine to prevent reactivation during chemotherapy: Two studies suggest the antiviral lamivudine should not be used in cancer patients who have inactive or resolved hepatitis B infections. Chemotherapy weakens the immune system and can contribute to life-threatening reactivation of hepatitis B. Because of this, physician often prescribe antivirals to prevent reactivations during cancer treatment. One study described two men, both HBeAg-negative, who was treated with chemotherapy for lymphoma. They were both given lamivudine during treatment to suppress any HBV DNA resurgence. However, several months after chemotherapy ended, both died from liver failure despite their continued lamivudine treatment. "Lamivudine should not be used for prophylaxis of patients with chronic hepatitis B with detectable HBV DNA undergoing chemotherapy with R-CHOP, even if they have never had exposure to lamivudine in the past," researchers wrote. "In this setting, lamivudine failure due to resistance can develop quickly leading to liver failure that cannot be salvaged with tenofovir." In another study, researchers compared the effectiveness of lamivudine, telbivudine (Tyzeka) and entecavir in preventing HBV reactivation after chemotherapy for a variety of cancers. They found lamivudine to be the least effective. - 435.Death from liver failure despite lamivudine prophylaxis during R-CHOP chemotherapy due to rapid emergence M204 mutations
- 906. Comparison of lamivudine, telbivudine, and entecavir as antiviral prophylaxis for patients with hepatitis B undergoing cytotoxic chemotherapy
专家：不要使用拉米夫定，防止重新在化疗过程中：两项研究表明，不应该使用的抗病毒药物拉米夫定在癌症患者中有非活动或解决B型肝炎感染。化疗会削弱免疫系统，并可能危及生命的激活B型肝炎正因为如此，医生常开的抗病毒药物在癌症治疗，以防止重新激活。
一项研究描述了两个男人，无论是HBeAg阴性，化疗治疗淋巴瘤的治疗。他们均给予拉米夫定治疗期间，禁止任何HBV DNA复苏。然而，数月后化疗结束后，都死于肝功能衰竭，尽管他们继续拉米夫定治疗。
“不应该被用于拉米夫定预防慢性乙型肝炎患者检测到HBV DNA，接受R-CHOP化疗，即使他们从未有过在过去曝光拉米夫定，”研究人员写道。 “在此设置中，拉米夫定电阻引起的故障可以迅速导致肝功能衰竭，无法打捞替诺福韦发展。”
在另一项研究中，研究人员比较了在预防多种癌症化疗后HBV再激活，拉米夫定，替比夫定（Tyzeka）和恩替卡韦。他们发现拉米夫定是最有效的。
拉米夫定预防R-CHOP化疗期间肝功能衰竭，尽管由于M204突变迅速崛起的435.Death
906。比较拉米夫定，替比夫定和恩替卡韦抗病毒预防乙肝患者接受细胞毒性化疗
| 
发表于 2012-11-18 16:56
