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1855
Profound Reduction of HBV Covalently Closed Circular
DNA with Long-term Nucleoside/tide Analogue Therapy
Ching-Lung Lai 1,2
, Danny Wong 1,2
, Philip Ip 3
, Malgorzata Kopaniszen 1
, Wai-Kay Seto 1,2
, James Fung 1,2
, Fung-Yu Huang 1
, Brian P. Lee 4
, Giuseppe Cullaro 5
, Chi Hang Wu 1
, Charles Cheng 1
, Chi Hang J. Yuen 1
, Vincent Ngai 1
, Man-Fung Yuen 1,2;
1 Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong;
2 State Key Laboratory for Liver Research, The University of Hong Kong, Hong
Kong SAR, Hong Kong;
3 Pathology, The University of Hong Kong,
Hong Kong SAR, Hong Kong;
4Medicine, Johns Hopkins University
School of Medicine, Baltimore, MD;
5Medicine, Columbia College
of Physicians and Surgeons, New York City, NY
Background: Long-term nucleoside/tide analogue (NA) treatment suppresses serum HBV DNA to undetectable levels in a
majority of patients. We aimed to investigate the effect of long-
term NA on the suppression of covalently closed circular DNA
(cccDNA) and intrahepatic HBV DNA (ihHBV-DNA). Methods:
We recruited 40 patients (median age 44.2 years, range
24.3-63.2) who had been on continuous long-term (5 – 10 years) NA. All patients had 3 liver biopsies: at baseline, after
1 year of treatment and at the last follow-up. Serum HBV DNA
and HBsAg were measured by the COBAS TaqMan HBV Test
and the Elecsys HBsAg II Assay, respectively (both Roche Diagnostics). ihHBV-DNA and cccDNA were assayed by real-time
PCR, with lower limits of detection of 0.001 and 0.005 copies/cell, respectively. Results: The median duration of treatment
was 10.5 years (range: 6.0 – 11.9 years). At baseline, 13
patients had 100mg lamivudine, 11 had 600mg telbivudine,
9 had 0.5mg entecavir, 4 had 30mg clevudine, and 3 had
10mg adefovir. At the last follow up, these patients were on
0.5-1.0mg entecavir (n=23), 600mg telbivudine (n=9), 10mg
adefovir (n=4), 300mg tenofovir (n=2), or combination therapy
of lamivudine plus adefovir/tenofovir (n=2). Histology of the
third biopsy showed complete resolution of interface hepatitis
in 60% of patients with the remainder showing mild-to-moderate activity. Persistent immunoreactivity for HBsAg was found
in 80%, the mean number of hepatocytes positive for HBsAg
being 10.4% (range 1-80%). All but 1 (2.5%) was immunoreactive for HBcAg. At baseline, the median serum HBV DNA,
HBsAg, ihHBV-DNA and cccDNA levels were 6.84 logIU/mL, 3.38 logIU/mL, 286 copies/cell, and 7.3 copies/cell,
respectively. At the time of the last biopsies, 36 (90%) patients
had undetectable serum HBV DNA (<20 IU/mL), all but one
patient still had detectable HBsAg (median: 2.74 logIU/mL),
all had detectable ihHBV-DNA (median: 0.4 copies/cell), but
18 (45%) patients had undetectable cccDNA. There was a
trend of reduction of HBsAg, ihHBV-DNA and cccDNA levels
from baseline to 1 year to last follow-up (all p<0.0001). The
median log drop of HBsAg at last biopsy was 0.55 logIU/mL.
The median percentage reductions of HBsAg, ihHBV-DNA and
cccDNA at last biopsies were 71.46%, 99.85% and 99.89%,
respectively. Conclusions: Long-term NA treatment significantly
reduced cccDNA and ihDNA. 45% of patients had undetectable cccDNA, although small amount of ihHBV-DNA were still
detectable in all patients. Integrated HBV DNA may be a possible source of detectable ihHBV-DNA and HBsAg. Continuous
long-term NA therapy can reduce cccDNA to undetectable
levels, suggesting a possible end-point of treatment.
Disclosures:
Ching-Lung Lai - Advisory Committees or Review Panels: Bristol-Myers Squibb,
Gilead Sciences Inc; Consulting: Bristol-Myers Squibb, Gilead Sciences, Inc;
Speaking and Teaching: Bristol-Myers Squibb, Gilead Sciences, Inc
Wai-Kay Seto - Advisory Committees or Review Panels: Gilead Science; Speak
-
ing and Teaching: Gilead Science, Bristol-Myers Squibb
Man-Fung Yuen - Advisory Committees or Review Panels: GlaxoSmithKline,
Bristol-Myers Squibb, Pfizer, GlaxoSmithKline, Bristol-Myers Squibb, Pfizer,
GlaxoSmithKline, Bristol-Myers Squibb, Pfizer, GlaxoSmithKline, Bristol-Myers Squibb, Pfizer; Grant/Research Support: Roche, Bristol-Myers Squibb,
GlaxoSmithKline, Gilead Science, Roche, Bristol-Myers Squibb, GlaxoSmithKline, Gilead Science, Roche, Bristol-Myers Squibb, GlaxoSmithKline, Gilead
Science, Roche, Bristol-Myers Squibb, GlaxoSmithKline, Gilead Science
The following people have nothing to disclose: Danny Wong, Philip Ip, Malgorzata Kopaniszen, James Fung, Fung-Yu Huang, Brian P. Lee, Giuseppe Cullaro,
Chi Hang Wu, Charles Cheng, Chi Hang J. Yuen, Vincent Ngai
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楼主: disan
发表于 2015-9-30 10:59
