表面抗原损失和持续的病毒抑制亚洲慢性乙型肝炎患者口服

StephenW

HIGH RATES OF SURFACE ANTIGEN LOSS AND SUSTAINED VIRAL SUPPRESSION IN ASIAN CHRONIC HEPATITIS B PATIENTS TREATED WITH ORAL ANTIVIRAL THERAPY: COMMUNITY-BASED REAL WORLD OUTCOMES
Author(s): Robert Wong
, My Nguyen
, Chuck Chan
, Huy Trinh
, Andrew Huynh
, Mytop Ly
, Huy Nguyen
, Khanh Nguyen
, Sharon Torres
, Jenny Yang
, Benny Liu
, Ruel Garcia
, Taft Bhuket
, Brian Levitt
, Eduardo DaSilvera
, Robert Gish

FRI-141

Topic: Hepatitis B & D - clinical (therapy, new compounds, resistance)

Background and aims
Chronic hepatitis B virus (HBV) is a leading cause of morbidity and mortality worldwide. While the majority of chronic HBV patients are from Asian-Pacific regions, large community-based real world outcomes on the effectiveness of antiviral therapies among this cohort are limited. The most definitive endpoint of antiviral therapy, surface antigen (HBsAg) loss with complete viral suppression and normalization of alanine aminotransferase (ALT), is rare. Furthermore, whether HBsAg loss correlates with undetectable virus and normalization of ALT on treatment, or risk of seroreversion or detectable virus after stopping therapy is not well reported. We aim to evaluate rates of HBsAg loss, baseline predictors of HBsAg loss, normalization of ALT and undetectable virus, and rates of HBsAg seroreversion or re-emergence of detectable virus among chronic HBV patients.

Methods
We retrospectively evaluated 1,072 adults (age >18) with chronic HBV on oral antiviral therapy at two large community gastroenterology clinics from June 1997 to October 2015. The majority (98.1%) were Asian ethnicity. Rates of HBsAg loss, normalization of ALT, achieving undetectable virus, and developing surface antibody (anti-HBs) were stratified by HBeAg status. Following HBsAg loss, rates of HBsAg seroreversion or re-emergence of detectable virus were analyzed. Multivariate logistic regression models evaluated for baseline and on-treatment predictors of HBsAg loss.

Results
With a mean follow up of 81.6 months and mean duration of treatment of 76.7 months, overall rate of HBsAg loss was 4.77% (n=51), with similar rates between HBeAg positive and negative patients (Table). Among HBsAg loss patients, 31.4% developed anti-HBs, 94.1% achieved undetectable virus, and 66.0% normalized ALT. Only 3.92% (n=2) who achieved HBsAg loss had detectable virus, whereas 17.3% (n=9) of HBsAg loss patients had seroreversion of positive HBsAg within 1-32 months. All 9 patients who seroreverted had sustained undetectable virus. No significant associations between baseline characteristics (age, ALT, platelets, HBeAg, FIB-4 score, APRI score) and HBsAg loss were seen.

Conclusions
Among a large community-based cohort of Asian chronic HBV patients, high rates of HBsAg loss were achieved with antiviral therapy. While 17.3% of patients experienced HBsAg seroreversion, all of these patients remained viral load undetectable, demonstrating the sustainability of HBsAg loss in most patients and stable suppression of HBV viral load.

StephenW

表面抗原损失和持续的病毒抑制亚洲慢性乙型肝炎患者口服抗病毒药物疗法治疗率高：以社区为基础REAL WORLD结果
作者（S）：罗伯特·黄
，我的阮
，查灿
，伊郑氏
安德鲁·黄长发
，Mytop阮文黎
，阮于伊
，阮庆
沙龙托雷斯
，杨珍妮
，本尼柳
，鲁埃尔·加西亚
塔夫脱Bhuket
布赖恩·莱维特
，爱德华多DaSilvera
罗伯特·吉什

FRI-141

主题：乙型肝炎＆D - 临床（治疗，新的化合物，电阻）

背景和目的
慢性乙型肝炎病毒（HBV）是全世界发病和死亡的一个主要原因。虽然大多数的慢性HBV患者都来自亚太地区，在这一人群中的抗病毒治疗的有效性大型社区为基础的现实世界的成果是有限的。抗病毒治疗，具有完整的病毒抑制和丙氨酸氨基转移酶（ALT）正常化表面抗原（HBsAg）损失的最权威的终点，是罕见的。此外，HBsAg消失是否与检测不到病毒治疗ALT复常，或seroreversion或可检测病毒的相关风险后没有得到很好的报告停止治疗。我们的目标是评估HBsAg消失，HBsAg消失的基线预测，ALT和检测不到病毒的正常化，与HBsAg seroreversion或可检测病毒的慢性乙肝患者中重新出现率率。

方法
我们回顾性评价1072成人（年龄> 18）与口服抗病毒治疗的慢性HBV两个大型社区诊所肠胃病1997年六月到十月2015年大部分（98.1％）为亚裔。 HBsAg消失，ALT的正常化，实现检测不到病毒，和显影表面抗体（抗​​HBs）的速率通过HBeAg状态分层。继HBsAg转阴，乙肝表面抗原seroreversion或可检测病毒的再次出现率进行了分析。多因素Logistic回归模型评估基线和治疗HBsAg转阴的预测。

结果
随着平均随访81.6个月，平均治疗76.7个月期限，HBsAg消失的总发生率为4.77％（51例），HBeAg阳性和阴性患者的发生率相似（见表）。在HBsAg消失患者中，31​​.4％发生抗-HBs，94.1％，实现了检测不到病毒，而66.0％归ALT。只有3.92％（2例）谁取得HBsAg消失了检测病毒，而17.3％（9例）的HBsAg转阴患者1-32个月内有HBsAg阳性seroreversion。所有9例谁seroreverted有持续检测不到病毒。基线特征之间无显著协会（年龄，ALT，血小板，大三阳，FIB-4分，APRI分）和HBsAg消失被看见。

结论
在亚洲慢性乙肝患者的大型社区为基础的队列，HBsAg转阴率高，用抗病毒治疗来实现。虽然患者的17.3％，乙肝表面抗原经历seroreversion，所有这些病人仍然病毒载量检测不到，这表明HBsAg消失在大多数患者和HBV病毒载量的稳定抑制的可持续性

东霸天

什么意思 ？ 求 高手给解释一下？

儒者也

此论文前后矛盾。
With a mean follow up of 81.6 months and mean duration of treatment of 76.7 months, overall rate of HBsAg loss was 4.77% (n=51), with similar rates between HBeAg positive and negative patients (Table).
经过平均76个月抗病毒治疗和81月随访，HBsAg消失率为4.77%，e抗原阳性和阴性消失率相当。
可Conclusion又提到：
Among a large community-based cohort of Asian chronic HBV patients, high rates of HBsAg loss were achieved with antiviral therapy. While 17.3% of patients experienced HBsAg seroreversion,
亚洲一个大区大量病例统计，抗病毒治疗后，17.3%的病人经历HBsAg血清转换。
问：
HBsAg消失率到底是4.77%，还是17.3%？
出现数字前后矛盾的错误，是否是内容不全？还是什么原因？

StephenW

回复 儒者也 的帖子

出现数字前后矛盾的错误，是否是内容不全？还是什么原因？

没有矛盾. 17.3% of patients experienced HBsAg seroreversion - 从HBsAg阴性回HBsAg阳性.翻译不好.

儒者也

StephenW 发表于 2016-4-28 23:20
回复 儒者也 的帖子

出现数字前后矛盾的错误，是否是内容不全？还是什么原因？

是这么回事！
4楼翻译不当。
谢谢指正！

儒者也

文章没有提到出现表面抗体HBsAb+（即31.4% developed anti-HBs）这部分病例，是否会出现HBsAg反复？
也就是说，这部分病例会否反弹？