依恩替卡韦依从性的慢性乙型肝炎患者低水平病毒血症和肝

StephenW

Low-level Viremia and Cirrhotic Complications in Patients With Chronic Hepatitis B According to Adherence to Entecavir
Seung Bum Lee  1 , Joonho Jeong  1 , Jae Ho Park  1 , Seok Won Jung  1 , In Du Jeong  1 , Sung-Jo Bang  1 , Jung Woo Shin  1 , Bo Ryung Park  2 , Eun Ji Park  2 , Neung Hwa Park  1   2
Affiliations

    PMID: 32466635 DOI: 10.3350/cmh.2020.0012

Abstract

Background/aims: Low-level viremia (LLV) after nucleos(t)ide analog treatment was presented as a possible cause of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, detailed information on patients' adherence in the real world was lacking. This study aimed to evaluate the effects of LLV on HCC development, mortality, and cirrhotic complications among patients according to their adherence to entecavir (ETV) treatment.

Methods: We performed a retrospective observational analysis of data from 894 consecutive adult patients with treatment-naïve CHB undergoing ETV treatment. LLV was defined according to either persistent or intermittent episodes of <2,000 IU/mL detectable hepatitis B virus DNA during the follow-up period. Good adherence to medication was defined as a cumulative adherence ≥90% per study period.

Results: Without considering adherence in the entire cohort (n=894), multivariate analysis of the HCC incidence showed that LLV was an independent prognostic factor in addition to other traditional risk factors in the entire cohort (P=0.031). Good adherence group comprised 617 patients (69.0%). No significant difference was found between maintained virologic response and LLV groups in terms of the incidence of liver-related death or transplantation, HCC, and hepatic decompensation in good adherence group, according to multivariate analyses.

Conclusions: In patients with treatment-naïve CHB and good adherence to ETV treatment in the real world, LLV during treatment is not a predictive factor for HCC and cirrhotic complications. It may be unnecessary to adjust their antiviral agent for patients with good adherence who experience LLV during ETV treatment.

Keywords: Carcinoma, Hepatocellular; Liver cirrhosis; Medication adherence; Hepatitis B.

StephenW

依恩替卡韦依从性的慢性乙型肝炎患者低水平病毒血症和肝硬化并发症
Seung Bum Lee 1，Joonho Jeong 1，Jae Ho Park 1，Seok Won Jung 1，In Du Jeong 1，Sung-Jo Bang 1，Jung Woo Shin 1，Bo Ryung Park 2，Eunji Park 2，Neung Hwa Park 1 2
隶属关系

    PMID：32466635 DOI：10.3350 / cmh.2020.0012

抽象

背景/目的：核苷酸（t）ide类似物治疗后的低水平病毒血症（LLV）被认为是慢性乙型肝炎（CHB）患者肝细胞癌（HCC）的可能原因。但是，缺乏有关患者在现实世界中依从性的详细信息。这项研究的目的是根据患者对恩替卡韦（ETV）治疗的依从性，评估LLV对HCC发育，死亡率和肝硬化并发症的影响。

方法：我们对894名接受过ETV治疗的未接受过治疗的CHB连续成年患者的数据进行了回顾性观察分析。 LLV是根据随访期间持续性或间歇性发作的<2,000 IU / mL可检测到的乙型肝炎病毒DNA定义的。对药物的良好依从性定义为每个研究期间累积依从性≥90％。

结果：不考虑整个队列的依从性（n = 894），对HCC发生率的多变量分析显示，除了整个队列中的其他传统危险因素外，LLV是独立的预后因素（P = 0.031）。良好依从性组包括617例患者（69.0％）。根据多变量分析，在良好依从性组中，维持病毒学应答与LLV组之间在与肝有关的死亡或移植，HCC和肝代偿失调的发生率方面没有显着差异。

结论：在真实世界中尚无初治性CHB且对ETV治疗依从性良好的患者，治疗期间的LLV并不是肝癌和肝硬化并发症的预测因素。对于在ETV治疗期间经历LLV的依从性良好的患者，可能无需调整其抗病毒药物。

关键字：肝细胞癌；肝硬化；药物依从性；乙型肝炎。

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2020-0012.pdf