DDW 2013：HBV抑制防止肝脏疾病进展？

StephenW

DDW 2013: Does HBV Suppression Prevent Liver Disease Progression?

   
    Published on Wednesday, 19 June 2013 00:00
    Written by Liz Highleyman



Chronic hepatitis B patients with cirrhosis may still experience liver disease progression even if they undergo antiviral treatment and achieve good virological response, according to a poster presented at the Digestive Disease Week meeting (DDW 2013) last month in Orlando.

Over years or decades, chronic hepatitis B virus (HBV) infection can lead to advanced liver damage including severe fibrosis, cirrhosis (scarring), and hepatocellular carcinoma (HCC, a form of primary liver cancer). This is largely related to immune activation and the liver's attempt to repair itself.

Treatment that suppresses HBV replication can slow liver disease progression and may even reverse some of the damage. A study presented at the recent EASL International Liver Congress in Amsterdam, for example, showed that long-term treatment with tenofovir (Viread) significantly lowered the risk of developing liver cancer after 5 or more years.

But lowering the risk of disease progression does not mean that it falls to zero.

Poh Seng Tan and colleagues from the National University of Singapore looked at outcomes among more than 260 chronic hepatitis B patients with cirrhosis who were on long-term nucleoside/nucleotide analog therapy using either lamivudine (Epivir-HBV) plus adefovir (Hepsera) combination therapy or entecavir (Baraclude) monotherapy. About 40% were hepatitis B "e" antigen (HBeAg) positive.

Lamivudine/adefovir recipients had been on treatment for a mean duration of about 40 months with a mean follow-up time of about 70 months. In the entecavir group the corresponding durations were about 35 and 45 months, respectively.

Results

    60% of participants in the lamivudine/adefovir group achieved undetectable HBV viral load at 1 year, rising to 92% at 3 years and 96% at 5 years.
    Virological response rates in the entecavir monotherapy group the were 75%, 95%, and 100%, respectively.
    Nevertheless, rates of liver disease progression in the lamivudine/adefovir group -- defined as liver decompensation, development of HCC, or death -- were 5% at 1 year, 18% at 3 years, and 33% at 5 years.
    Progression rates in the entecavir group somewhat lower at 8%, 13%, and 18%, respectively.
    The cumulative probability of liver disease progression was not dependent on achieving undetectable viral load.
    Among virological responders, there was no significant difference in risk of disease progression between the lamivudine/adefovir and entecavir groups.
    Decompensation at baseline and serum albumin level -- but not virological response -- were significant predictors of disease progression in a multivariate analysis.

Based on these findings, the researchers concluded, "Among cirrhotics treated with long-term [lamivudine/adefovir] combination therapy or entecavir monotherapy, despite the excellent antiviral efficacy, there was still significant probability of liver disease progression."

6/19/13

Reference

PS Tan, YY Dan, K Lim, and SG Lim. Virological Response Does Not Lower Liver Disease Progression Among Chronic Hepatitis B Cirrhotic Patients Treated With Long-Term Nucleos(t)ide-Analogue. Digestive Disease Week (DDW 2013). Orlando, May 18-21, 2013. Abstract Sa1012.

StephenW

慢性乙肝肝硬化患者可能仍然会遇到即使他们接受抗病毒治疗肝脏疾病的进展，并实现良好的病毒学应答，根据消化疾病周会议（DDW 2013）上个月在奥兰多的海报。

在几年或几十年，慢性乙型肝炎病毒（HBV）感染可导致先进的肝功能损害，包括严重的肝纤维化，肝硬化（疤痕），肝癌（肝癌，原发性肝癌的一种形式）。这主要是相关的免疫活化和肝脏的自我修复。

治疗，抑制乙肝病毒复制，延缓肝病进展，甚至可能扭转一些损害。 EASL最近在阿姆斯特丹国际肝病会议提出，例如，研究表明，替诺福韦（Viread的）显着的长期治疗5个或更多年后罹患肝癌的风险降低。

但是，降低病情恶化的风险并不意味着它下降到零。

傅生谭和来自新加坡国立大学的同事们看着在260多名慢性乙肝患者长期核苷/核苷酸类似物治疗，可以使用拉米夫定（拉米HBV）加上阿德福韦（阿德福韦酯）联合治疗肝硬化成果或恩替卡韦（博路定）单药治疗。约有40％是B型肝炎的“e”抗原（HBeAg）阳性。

拉米夫定/阿德福韦受助的治疗已经平均持续约40个月，平均随访时间约70个月。恩替卡韦组相应的持续时间约35个月和45个月，分别。

结果

    取得拉米夫定/阿德福韦组中的参与者不到HBV病毒载量的60％在1年，上升至92％，​​在3年，5年和96％。
    恩替卡韦单药治疗组的病毒学应答率分别为75％，95％和100％，分别。
    然而，在拉米夫定/阿德福韦组的肝脏疾病进展率 - 定义为肝功能失代偿，肝癌的发展，或死亡 - 分别为5％，1年，3年的18％，5年和33％。
    恩替卡韦组稍低，分别为8％，13％和18％，升学率。
    肝脏疾病进展的累积概率是不依赖于实现检测不到病毒载量。
    在病毒学应答，疾病进展风险之间的拉米夫定/阿德福韦和恩替卡韦组无显着差异。
    失代偿期在基线血清白蛋白水平 - 而不是病毒学应答 - 多变量分析中的显着预测疾病进展。

基于这些发现，研究人员得出结论，“在长期治疗的肝硬化[拉米夫定/阿德福韦联合治疗或恩替卡韦单药治疗，尽管优秀的抗病毒疗效，有肝脏疾病进展的概率依然显着。”

13年6月19日

参考

YY PS谭丹，K林，和SG林的。病毒学应答不降低肝病恶化，其中慢性乙型肝炎治疗的肝硬化患者有长期核苷（酸）IDE模拟。消化疾病周（DDW 2013年）。奥兰多，2013年5月18-21日。摘要Sa1012。

咬牙硬挺

抗病毒也不能消除死亡的威胁啊