第4周病毒载量预测抗病毒治疗过程中HBV DNA的长期抑制：改善

StephenW

Intern Med J. 2016 Aug 30. doi: 10.1111/imj.13244. [Epub ahead of print]
Week 4 viral load predicts long-term suppression of HBV DNA during antiviral therapy: improving hepatitis B treatment in the real world.Truong J1, Shadbolt B2, Ooi M1, Chitturi S1, Kaye G1, Farrell GC1, Teoh NC1.
Author information

• 1Australian National University Medical School and Gastroenterology and Hepatology Unit, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia.
• 2Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia.
  

AbstractBACKGROUND: Entecavir and tenofovir potently suppress hepatitis B virus (HBV) replication so that serum HBV DNA levels <20 IU/mL can be achieved after 2 years. Despite this, inadequate suppression is reported in >20% of cases for unclear reasons.
AIM: We tested whether 4-week (wk) viral load (VL) assessment could improve 96-wk treatment outcome.
METHODS: Data on all chronic hepatitis B patients treated with entecavir or tenofovir between 2005-2014 were entered prospectively. Full data capture included pre-treatment, weeks 4, 24, 48 and 96 HBV DNA titre, HBeAg, age, gender, antiviral agent and dose escalation. Compliance data were compiled from pharmacy records, doctors' letters and clinic bookings/attendance. Time to achieve complete viral suppression (HBV DNA <20 IU/mL) was graphed using Kaplan-Meier curves. Factors affecting this were examined using a multivariate Cox Proportional Hazard model.
RESULTS: Amongst 156 patients treated, 72 received entecavir and 84 tenofovir. Pre-treatment HBV DNA titre, 4wk assessment and compliance impacted significantly on time to complete viral suppression. At 96wk, 90% of those assessed as compliant by 4wk HBV DNA had complete viral suppression versus 50% followed by 6 month VL estimation. Continuing care by the same physician was related to 4wk VL testing and optimal compliance.
CONCLUSIONS: Medium-term outcomes of HBV antiviral therapy are improved by early on-treatment VL testing, facilitating patient engagement and improved compliance. The observation that 90% complete viral suppression after 2 years monotherapy is achievable in a routine clinic setting questions the need for combination therapy in HBV cases with suboptimal response.
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KEYWORDS: HBV viral load; compliance; dose adjustment; entecavir; on-treatment monitoring; real world therapy; tenofovir

PMID:27571991DOI:10.1111/imj.13244

StephenW

内科杂志2016年J.月30 DOI：10.1111 / imj.13244。 [打印EPUB提前]
第4周病毒载量预测抗病毒治疗过程中HBV DNA的长期抑制：改善在现实世界中乙肝治疗。
张庭J1，夏伯特B2，M1大井，Chitturi S1，凯G1，法雷尔GC1，赵明福NC1。
作者信息

    1Australian国立大学医学院和胃肠病学和肝病股，堪培拉医院，扬巴驱动器，加兰，ACT，2605，澳大利亚。
    2Centre流行病传播和信息技术，堪培拉医院，扬巴驱动器，加兰，ACT，2605，澳大利亚进展。

抽象
背景：

恩替卡韦和替诺福韦强效抑制乙型肝炎病毒（HBV）的复制，使血清HBV DNA水平<20 IU / mL的可在2年后才能实现。尽管这样，抑制不足中报告原因不明的情况下> 20％。
目标：

我们测试了4周（周）病毒载量（VL）的评估是否能提高96周的治疗结果。
方法：

与2005年至2014年间的恩替卡韦或替诺福韦治疗的所有慢性乙型肝炎患者的数据进行前瞻性输入。全部数据采集包括前处理，周4，24，48和96 HBV DNA滴度，大三阳，年龄，性别，抗病毒药物和剂量递增。合规性数据是从药房记录，医生的信件和门诊预约/考勤编译。时间达到完全抑制病毒（HBV DNA <20 IU / mL）的使用Kaplan-Meier曲线绘制。使用多变量Cox比例风险模型影响该因素进行了检查。
结果：

治疗当中156例，72收到恩替卡韦和替诺福韦84。治疗前HBV DNA滴度，4wk组评估和合规性上的时间显著影响来完成病毒抑制。在96wk，90％由那些4wk组HBV DNA评定为标准的有完整的病毒抑制比50％，其次是6个月VL估计。由同一个医生持续护理是4wk组VL测试和优化合规性有关。
结论：

乙肝抗病毒治疗的中期结果是由早期治疗VL测试的提高，有利于病人的参与和提高合规性。经过2年的单药治疗观察，90％完全抑制病毒是在例行诊所设置的问题在HBV例疗效欠佳联合治疗的需要实现的。

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关键词：

HBV病毒负荷;合规性;调整剂量;恩替卡韦;在治疗监测;现实世界的治疗;替诺福韦

结论：
    27571991
DOI：
    10.1111 / imj.13244

重生一次

什么意思不明白

StephenW

回复 重生一次 的帖子

没有大消息. 病毒治疗,医生应监测服药依从性(测试HBV DNA滴度, 药房记录)可以提高病毒抑制率.

REMEMBERFORGET

The observation that 90% complete viral suppression after 2 years monotherapy is achievable in a routine clinic setting questions the need for combination therapy in HBV cases with suboptimal response.
恩替或者替诺，单独治疗两年后，90%的病人取得完全病毒抑制（即：DNA定量<20iu/ml）。
其余（即10%没有取得完全病毒抑制）疗效欠佳的病人，需要恩替和替诺联合治疗。

StephenW

回复 REMEMBERFORGET 的帖子

谢谢你.

我的谷歌翻译是不正确的!

"questions the need for combination therapy in HBV cases with suboptimal response."
质疑单独治疗不理想的反应是否需要组合疗法。