恩替韦耐药停药，给身体激发免疫力的一个机会，可行吗？

为了小心肝

“我不知道怎么阅读耐药性试验。该报告指出，恩替卡韦耐药。报告说你有拉米夫定，阿德福韦酯耐药吗？”，以前只用过代丁，效果不佳，病毒量10的4、5 次方，当然认为是抑制病毒不强药物本身问题，未用过拉米，都未怀疑两者有耐药，也未做过耐药测试，这次由于恩替怀疑耐药了，才检测基因发现"左旋核苷酸、恩替卡韦耐药"，不知阿德福韦脂、拉米夫定是不是左旋核苷酸？

为了小心肝

“这是可能的，因为一些科学家认为，抑制病毒多年后,一些患者的T细胞免疫可以恢复，停止抗病毒药物或添加/更改干扰素，可以清除病毒。有正在进行的临床试验，以证实这些思想。
但在你的情况下，现时你的病毒载量升高，这似乎表明这个思想可能并不适用.”
我的“病毒载量升高，并不适用”，是指T细胞免疫应答不佳吗？

z3f

楼主很淡定的样子！

为了小心肝

z3f 发表于 2013-10-30 08:57
楼主很淡定的样子！

总是纠结、忧愁于病情无益，目前也只能顺其自然，走好下面的路吧

disHBV

z3f 发表于 2013-10-29 20:32
说实话，目前没有看到楼主有效的病情数据！
我的几个问号也没有回答全！
最好不是乌龙球！

S大叔一出现，讨论方向往往要改变

disHBV

为了小心肝 发表于 2013-10-29 23:28
拟行治疗方案 是，如ALT达500了，上干扰素，其他就只要观察、定期复查或对症治疗，谢谢提醒。
...

你也盯上ALT500啦，我觉得目前的80要重议
不过ALT500以上还合适打干扰素吗？医院好像不给打的

燕尾乱飘

楼主你曾经打过一年的派没有获得成功吧。这个事实对你停核苷再上干扰，有何启示？

StephenW

回复 为了小心肝 的帖子

"半年后出现耐药，后加用阿德，效果不佳。"
在中国，恩替耐药, 建议用恩替+阿德
。
我有这个（英文论文）:

TITLE: Genotypic and phenotypic characteristics of HBV entecavir resistance in Chinese patients

AUTHORS (FIRST NAME, LAST NAME): Yan Liu1, Zhihui Xu1, Liming Liu1, Xiaodong Li1, Jiuzeng Dai1, Zengtao Yao1, Li Chen1, Siyu Bai1, Shaojie Xin1, Dongping Xu1

Institutional Author(s):

INSTITUTIONS (ALL): 1. Institute of Infectious Diseases and Liver Failure Research Center, Beijing 302 Hospital, Beijing, China.

ABSTRACT BODY: Background/Aim: The study aimed to investigate HBV ETV resistance profile of Chinese patients in clinical practice. Methods: Serum samples from 18,419 patients collected from July 2007 to June 2012 in Beijing 302 Hospital were screened. Genotypic resistance was detected by direct PCR sequencing and confirmed by clonal sequencing if necessary. Phenotypic resistance was analyzed by measuring HBV replication capacity under drug pressure in HepG2 cells. Results: ETV-resistant mutations were detected from 646 samples and the incidence had been increased in the past five years (1.91%, 2.23%, 3.54%, 3.96%, and 4.77%). Mutational pattern analysis showed that concomitant with rtM204V/rtM204I, mutations at rt184, rt202, rt250, and two of rt184/rt202/rt250 sites were 57.4%, 22.4% and 14.1%, and 6.1%, respectively (Figure 1). Nineteen percent (123/646) of ETV-resistant samples harbored rtM204I±L80I/L180M-based pattern rather than rtL180M+M204V-based pattern. Among them 70 samples only harbored two resistant mutations (rtM204I+T184I x 39, rtM204I+M250L x 26, rtM204I+M250I x 5). All ETV-resistant strains exhibited varied lower natural replication capacity compared to wild-type strains in vitro. ETV susceptibility of rtL180M+M204V-based ETV-resistant mutants was usually lower than rtM204I-based ETV-resistant mutants. Replication of all tested ETV-resistant strains could be effectively suppressed by tenofovir and adefovir in vitro. In clinical practice, adding-on adefovir was more efficacious than switching-to adefovir as a rescue therapy for ETV-resistant patients. Conclusions: The occurrence of ETV-resistant HBV infection kept growing in the past five years in Chinese patients. ETV-resistant mutational pattern diversified and rtM204I-containing ETV-resistant strains occupied near 1/5 of the patients. ETV-resistant strains could be suppressed by tenofovir or adefovir in vitro; and currently, adding-on adefovir was a practical rescue therapy in clinical practice in China.

(No Table Selected)

Figure 1. Incidence of entecavir-resistant mutations in recent five years

Co-Author Disclosure Status

The following authors have completed their AASLD 2013 disclosure: Yan Liu: Disclosure completed | Zhihui Xu: Disclosure completed | Liming Liu: Disclosure completed | Xiaodong Li: Disclosure completed | Jiuzeng Dai: Disclosure completed | Zengtao Yao: Disclosure completed | Li Chen: Disclosure completed | Siyu Bai: Disclosure completed | Shaojie Xin: Disclosure completed | Dongping Xu: Disclosure completed

---

StephenW

回复 为了小心肝 的帖子

我的“病毒载量升高，并不适用”，是指T细胞免疫应答不佳吗？

我个人的理解: 如果你的T细胞免疫功能恢复, 它应该已经能够控制病毒载量上升.
免疫学是非常复杂的，当然我不是专家.