新的丙型肝炎治疗导致乙肝合并感染的患者重新激活危险

StephenW

Wednesday, July 1, 2015                  New Hepatitis C Treatment Causes Dangerous Reactivation of Hepatitis B in Coinfected Patients
by Christine M. Kukka

Coinfected patients treated with new, successful hepatitis C antivirals drugs face a potentially life-threatening reactivation of their hepatitis B infection—even if their hepatitis B is resolved or inactive.
Up to 30 percent of people infected with hepatitis C are also infected with hepatitis B. In these coinfected patients, hepatitis C becomes the “dominant” virus in the liver and suppresses hepatitis B to barely detectable levels. When the new antiviral drugs, including sofosbuvir (Solvadi) are used, hepatitis B can resurge as hepatitis C retreats.

In the past, hepatitis C treatment used the antiviral ribavirin and pegylated interferon. While ribavirin targeted only hepatitis C, the interferon treatment helped the immune system fight both hepatitis C and B.

Today’s fast-acting hepatitis C treatment contains only antivirals that target only hepatitis C. Once hepatitis C is eradicated, doctors are finding a few cases where coinfected patients quickly experience a dangerous reactivation of their hepatitis B infection, even if they had “inactive” or resolved hepatitis B.

This discovery is significant, according to a report published in the current issue of the journal of Clinical Infectious Diseases, because current hepatitis C treatment guidelines, “do not offer specific guidance on treatment and monitoring of patients coinfected with hepatitis B.”

As a result, doctors don’t know they should be looking for hepatitis B reactivation in patients treated with sofosbuvir and simeprevir. However, coinfected patients may be among the first treated with the new drugs by doctors and Veterans Administration clinics because coinfections can produce more serious liver damage that requires treatment.

The journal article reports on two coinfected patients treated with sofosbuvir and simeprevir. One patient achieved undetectable hepatitis C viral load within four weeks, but seven weeks after starting treatment he developed jaundice and abdominal pain. Doctors at Emory University School of Medicine discovered he had a sudden reactivation of hepatitis B. His hepatitis B viral load, which had been very low before treatment, jumped into the millions and blood tests revealed severe liver damage.

Doctors stopped treatment and started him on the hepatitis B antiviral tenofovir (Viread), which quickly controlled the hepatitis B flare. After 28 weeks, the patient’s hepatitis B remained under control and he remained cured of hepatitis C.

In the second reported case, a patient who had cleared a hepatitis B infection and had hepatitis B surface antibodies, was treated with the same antivirals. This time, doctors monitored his hepatitis B and C viral load every two weeks. As expected, the hepatitis C virus disappeared while the hepatitis B viral load rapidly rose. This time, doctors added tenofovir to the ongoing treatment and 12 weeks later the patient tested undetectable for both viruses.

Researchers urged doctors to screen hepatitis C patients for signs of past or current hepatitis B infections before starting the new treatment, and to monitor hepatitis B viral load during treatment.

For more information: http://www.ncbi.nlm.nih.gov/pubmed/26082511

Posted byHCV Advocateat10:17 A

StephenW

周三，2015年7月1日
新的丙型肝炎治疗导致乙肝合并感染的患者重新激活危险
恭M. Kukka

用新的，成功的丙型肝炎抗病毒药药物治疗合并感染的患者面临其乙型肝炎的一个潜在的威胁生命活化感染，即使它们的乙型肝炎得到解决或不活动的。
达的人感染丙型肝炎同时感染乙型肝炎在这些合并感染的患者的30％，丙型肝炎变成“显性”病毒在肝和抑制乙肝至几乎检测不到的水平。当新的抗病毒药物，包括索非布韦（Solvadi）时，B型肝炎可以死灰复燃丙型肝炎后退。

在过去，C型肝炎的治疗中使用的抗病毒药利巴韦林和聚乙二醇化干扰素。虽然利巴韦林只针对丙型肝炎的干扰素治疗帮助免疫系统对抗双方丙型肝炎和B

今天的速效丙肝治疗仅包含只针对丙型肝炎一旦丙型肝炎根除，医生发现少数情况下，合并感染的患者迅速体验他们的乙肝感染的危险激活，即使他们有“不活动”或抗病毒药物解决乙肝

这一发现是显著，根据发表在临床传染病杂志的最新一期的报告，因为目前的丙肝治疗指南，“不提供治疗和监测患者的具体指导与乙型肝炎合并感染”

这样一来，医生不知道他们应该寻找乙肝激活与索非布韦和simeprevir治疗的患者。然而，合并感染的患者可能是最早与新的药品由医生和退伍军人管理局诊所治疗，因为混合感染可产生更严重的肝损伤，需要治疗。

该杂志文章报道与索非布韦和simeprevir治了合并感染的患者。一名患者在四个星期内完成检测不到丙肝病毒载量，但在开始治疗七周后，他开发的黄疸和腹痛。医生在埃默里大学医学院发现他有乙肝他的乙肝病毒载量，这一直是非常低的治疗前突然激活，跳进了数以百万计，并抽血化验显示严重的肝损害。

医生停止治疗，并开始他的乙肝抗病毒药替诺福韦（Viread的），从而迅速控制了乙肝耀斑。 28周后，患者的乙肝仍在控制之中，他仍然治愈丙型肝炎。

在第二种情况报告，一个病人谁已经清除了乙肝病毒感染和有乙肝表面抗体，用同样的抗病毒药物治疗。这一次，医生监测他的乙肝和丙肝病毒载量每两个星期。正如预期的那样，C型肝炎病毒消失，而乙肝病毒载量迅速上升。这一次，医生替诺福韦加入到持续治疗12周后，患者无法检测测试两种病毒。

研究者敦促医生筛选丙型肝炎患者对过去或当前乙型肝炎感染的迹象在开始新的治疗前和治疗过程中监测乙型肝炎病毒载量。

欲了解更多信息：http://www.ncbi.nlm.nih.gov/pubmed/26082511
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