HBeAg 阳性患者停用替诺福韦与恩替卡韦后乙型肝炎病毒复发

StephenW

HBeAg 阳性患者停用替诺福韦与恩替卡韦后乙型肝炎病毒复发率更高且更早
Chen Chien-Hung 1 , Cheng-Yuan Peng 2 3 , Yuan-Hung Kuo 1 , Tsung-Hui Hu 1 , Chao-Hung Hung 1 , Jing-Houng Wang 1 , Sheng-Nan Lu 1
隶属关系
隶属关系

    1
    台湾高雄长庚纪念医院及长庚大学医学院内科肝肠胃科。
    2
    台中中国医科大学附属医院内科消化内科中心。
    3
    中国医科大学医学院，台中，台湾。

    PMID：34894128 DOI：10.1093/infdis/jiab596

抽象的

背景：本研究调查了停用恩替卡韦或富马酸替诺福韦酯 (TDF) 的乙型肝炎 e 抗原 (HBeAg) 阳性慢性乙型肝炎 (CHB) 患者乙型肝炎病毒 (HBV) 复发的发生率和预测因素。

方法：共招募了 205 名和 111 名分别停止恩替卡韦或 TDF 治疗至少 6 个月的无肝硬化的 HBeAg 阳性患者。

结果：在整个队列中，治疗期间出现 HBeAg 血清学转换的患者和倾向评分 (PS) 匹配的患者、停用 TDF 的患者的病毒学和临床复发率显着高于停用恩替卡韦治疗的患者。在整个队列和亚组分析中，多变量分析确定 TDF 与病毒学和临床复发独立相关。治疗期间 HBeAg 消失且未形成抗 HBe 抗体的患者，其治疗后 HBV 复发率和 HBeAg 血清学逆转率显着高于治疗期间发生 HBeAg 血清学转换的患者。治疗结束时 (EOT) 的 HBcrAg 水平与所有患者和治疗期间出现 HBeAg 血清学转换的患者的 HBV 复发和 HBeAg 血清学逆转独立相关。

结论：在停用恩替卡韦或 TDF 的 HBeAg 阳性患者中，TDF 治疗、治疗期间无血清学转换的 HBeAg 消失和 EOT 时较高的 HBcrAg 水平是 HBV 复发的重要预测因素。

关键词：慢性乙型肝炎；恩替卡韦；乙肝核心相关抗原；乙型肝炎表面抗原；替诺福韦。

© The Author(s) 2021。牛津大学出版社为美国传染病学会出版。版权所有。如需权限，请发送电子邮件至：[email protected]。

StephenW

Earlier and higher rate of hepatitis B virus relapse after discontinuing tenofovir versus entecavir in HBeAg-positive patients
Chen Chien-Hung  1 , Cheng-Yuan Peng  2   3 , Yuan-Hung Kuo  1 , Tsung-Hui Hu  1 , Chao-Hung Hung  1 , Jing-Houng Wang  1 , Sheng-Nan Lu  1
Affiliations
Affiliations

    1
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
    2
    Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung.
    3
    School of Medicine, China Medical University, Taichung, Taiwan.

    PMID: 34894128 DOI: 10.1093/infdis/jiab596

Abstract

Background: This study investigated the incidence and predictors of hepatitis B virus (HBV) relapse in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) who discontinued entecavir or tenofovir disoproxil fumarate (TDF).

Methods: A total of 205 and 111 HBeAg-positive patients without cirrhosis who had stopped entecavir or TDF treatment, respectively, for at least 6 months were recruited.

Results: In the entire cohort, patients with HBeAg seroconversion during treatment and propensity score (PS)-matched patients, patients who discontinued TDF had significantly higher rates of virological and clinical relapse than patients who discontinued entecavir therapy. Multivariate analysis identified TDF were independently associated with virological and clinical relapse in the entire cohort and subgroups analysis. Patients with HBeAg loss without anti-HBe antibody formation during treatment had significantly higher rates of off-therapy HBV relapse and HBeAg seroreversion than patients with HBeAg seroconversion during treatment. The HBcrAg level at end of treatment (EOT) was independently associated with HBV relapse and HBeAg seroreversion in all patients and patients with HBeAg seroconversion during treatment.

Conclusions: TDF therapy, HBeAg loss without seroconversion during treatment and higher HBcrAg levels at EOT are significant predictors of HBV relapse in HBeAg-positive patients who discontinued entecavir or TDF.

Keywords: chronic hepatitis B; entecavir; hepatitis B core related antigen; hepatitis B surface antigen; tenofovir.

© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].