关于博路定的设想，请战友发表看法

nwjk

对多数病友来说，使用博路定降低DNA病毒量数据，可能还是不错的，这种药的副作用也比较小。如果在病毒量转阴以后，再巩固1年，就试着减少用量，从每天1片逐渐减少至每两天或3天一片。各位觉得如何呢？

富贵数字

想法不错 。

富贵数字

楼主现在DNA是阴了吗

ybdn

为什么要这样吃？是为了省钱吗？

StephenW

回复 nwjk 的帖子

我发这帖帮你参考(报告的日期为2008年1月).我不是医生或专家.

报告没有提到停止恩替卡韦(博路定).报告太长，许多部分被切断，完整的文章看文章的链接.

“何时停止“是非常复杂。不是所有的医生有相同的看法。你必须和肝病专家磋商,合作。普通医生没有这方面的训练。


"停止抗病毒治疗>一旦启动抗病毒治疗，患者应定期监测，以评估药物疗效，安全性和耐受性，并发现耀斑和认识疾病的药物抗药性的发展，一个监测进一步的目的是评估病患的顺从性[ 2]。乙肝病毒DNA和转氨酶水平至少应监测，每3-6个月，而患者正在接受治疗的口服药物。此外，患者接受聚乙二醇干扰素α应经常监测的副作用的耐受性，可能降低包括类似感冒的症状，抑郁症，骨髓抑制和神经精神疾病的发展。聚乙二醇干扰素α- 2a的是管理的一个固定期限1年。过早停止治疗只有是无法忍受副作用（这些发生在<5％的患者）。 停药时间,HBeAg阳性，抗- HBe和HBV DNA水平应进行评估，和每6个月后。
在与与e抗原阳性慢性乙型肝炎患者口服药物传统治疗终点是HBeAg的血清转换到协会抗- HBe非常低或测不到血清HBV DNA水平[1？？？5]。治疗通常持续增加6-12个月，以减少复发的可能性。有些医师赞成与肝硬化患者口服药物长期治疗，即使HBeAg血清转换，以避免复发的危险。在这一点上，存在太少数据，不以确定最佳点时停止定居。扩展或口服抗病毒药物治疗可能会无限期适当肝硬化患者。目前还不知道什么是最好的治疗终点为HBeAg阴性患者。但是，如果检测不到HBV DNA水平和治疗成为终止，复发率很高。在这种情况下，目前的数据支持长期口服抗病毒药物治疗。复发率可能较低，尽管仍然很大，如果检测不到HBV DNA的水平已维持数年。在一项研究中，三分之二的病患者4-5年的治疗后停用阿德福韦,维持正常的ALT水平15-20个月后[21].
.


Author: [email protected]
Date: 2008-05-12 17:47 +1000
Subject: FW: Current approaches for treating chronic hepatitis B: when to   start, what to start with, and when

  http://www.springerlink.com/content/01k4581303255628/fulltext.html> > Hepatology International > 10.1007/s12072-008-9059-0 > > ORIGINAL ARTICLE> Current approaches for treating chronic hepatitis B: when to start, what to start with, and when to stop > > Ting-Tsung Chang1 and Dong Jin Suh2> > (1) Department of Medicine, National Cheng Kung University, Medical College and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan > (2) Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea > > > Ting-Tsung Chang> Email: [email protected] > > Received: 12 December 2007 Accepted: 24 January 2008 Published online: 5 March 2008 > > Abstract The natural course of hepatitis B virus (HBV) infection is variable, and chronic hepatitis B (CHB) disease exhibits itself through a spectrum of clinical manifestations. These factors contribute to the challenges faced when managing patients who live with HBV infection. Furthermore, conventional treatment options (e.g., interferon alfa-2a, lamivudine, and adefovir) are moderately effective and can be associated with problems, such as poor tolerability (interferon alfa-2a) and the development of drug resistance (lamivudine). Over the last 5 years, several antiviral agents including entecavir, peginterferon alfa-2a, and telbivudine which are more efficacious and have improved tolerability over previous drugs have become available. The availability of novel antiviral agents and advances in understanding resistance patterns of antiviral agents has resulted in refinement of CHB treatment recommendations and guidelines. More recently, evidence from clinical trials suggests the central importance of virologic suppression as an indicator of treatment outcome and the predictive value of on-treatment HBV DNA levels in response to antiviral therapy. This review highlights the goals of therapy and clinical experience with therapies that are newly licensed or in the late stages of clinical development. Current approaches for treating CHB and new strategies for optimizing response to therapy are also discussed. > Keywords Chronic hepatitis B - Human immunodeficiency virus - Hepatitis B e antigen > > Abbreviations ALT Alanine aminotransferase - AST Aspartate aminotransferase - CHB Chronic hepatitis B - HBeAg Hepatitis B e antigen - HBsAg Hepatitis B surface antigen - HBV Hepatitis B virus - HIV Human immunodeficiency virus - PCR Polymerase chain reaction - PEG Polyethylene glycol - NA Nucleoside or nucleotide analog - ULN Upper limit of normal > > --------------------------------------------------------------------------------> > Introduction> Profound and sustained inhibition of viral replication is the most important goal of the management of chronic hepatitis B (CHB), as it can reduce the likelihood of subsequent disease progression and the emergence of viral resistance. Despite the availability of potent antiviral agents, response to therapy remains less than satisfactory, and the emergence of resistance remains a barrier to achieving the goals of therapy. Guidelines for the management of CHB address the criteria for patient selection, the objectives and timing of therapy, and the advantages and disadvantages of available treatment options, but little information is available on treatment monitoring and strategies for optimizing patient outcomes [1???5]. Emerging evidence from clinical studies of antiviral agents suggest that on-treatment serum levels of hepatitis B virus (HBV) DNA are predictive of treatment response [6???9]. Based on these findings, a panel of international experts has proposed an algorithm for optimizing treatment response that relies on the on-treatment monitoring of HBV DNA levels [10]. Combination antiviral therapy and add-on therapy have also been investigated as potential strategies for improving treatment outcomes in patients with CHB. This review highlights current opinion on when to start antiviral therapy and when to stop CHB treatment, citing clinical experience with newly available agents and agents in the late stages of development. New strategies for optimizing response to therapy are also discussed. > > > --------------------------------------------------------------------------------> > Initiation of therapy and the goal of treatment> The fundamental goal of CHB therapy is to reduce progression to cirrhosis, hepatic decompensation with liver failure, development of hepatocellular carcinoma, and the need for liver transplantation by achieving a sustained reduction of viral replication to undetectable levels [3???5]. > > During the initial evaluation of an individual at high risk of hepatitis B, physicians should obtain the patient???s history and the family history of liver disease, ask about alcohol use, and perform a physical examination [5]. Laboratory tests should include a complete blood cell count, assessment of liver transaminase levels, and the performance of other assays needed to assess liver disease. Serologic testing for the presence of HBV should include assays for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and HBV DNA levels. In addition, patients should be screened for the presence of coinfection with hepatitis A virus (HAV), hepatitis C virus, hepatitis D virus, and human immunodeficiency virus (HIV), as co-infection is associated with more severe liver disease [5]. Liver biopsy may be useful, especially in patients who do not clearly meet the criteria for starting treatment. > > CHB follows a variable clinical course that can be characterized by four distinct phases: immune tolerance, immune clearance (HBeAg-positive CHB), inactive HBsAg carrier, and reactivation (HBeAg-negative CHB) [11]. The criteria used to define each phase of infection include the presence or absence of HBeAg, serum HBV DNA levels, alanine aminotransferase/aspartate aminotransferase (ALT/AST) levels, and necroinflammation on liver biopsy (Table 1) [11]. The persistence of HBsAg beyond 6 months is adequate for a diagnosis of CHB [1???5]. > Table 1 Phases of chronic HBV infection > Phase> Diagnostic criteria> > Immune tolerance> 1. HBsAg-positive>6 months> > 2. HBeAg-positive, anti-HBe-negative> > 3. Serum HBV DNA>20,000 IU/ml> > 4. Persistently normal ALT levels> > 5. Liver biopsy normal or showing minor nonspecific changes> > Immune clearance (HBeAg- positive CHB)> 1. HBsAg-positive>6 months> > 2. HBeAg-positive, anti-HBe-negative> > 3. Serum HBV DNA>20,000 IU/ml> > 4. Persistent or intermittent elevation of ALT levels> > 5. Liver biopsy showing chronic hepatitis (necroinflammatory score ???4)a > > Inactive HBsAg carrier> 1. HBsAg-positive>6 months> > 2. HBeAg-negative, anti-HBe-positive> > 3. Serum HBV DNA <2,000 IU/ml> > 4. Persistently normal ALT levels> > 5. Liver biopsy showing absence of significant hepatitis (necroinflammatory score <4)a > > Reactivation (HBeAg-negative CHBb) > 1. HBsAg-positive>6 months> > 2. HBeAg-negative, anti-HBe-positive> > 3. Serum HBV DNA>2,000 IU/ml> > 4. Persistent or intermittent elevation of ALT levels> > 5. Liver biopsy showing chronic hepatitis (necroinflammatory score ???4)a > > > Note: From Yim and Lok [11] > aLiver biopsy optional > bMost of these patients have precore or core promoter variants > Treatment is currently recommended only for patients with the immune clearance and reactivation phases. However, all newly diagnosed patients infected with HBV should be followed for ???6 months before the institution of antiviral therapy, because of the potential for spontaneous HBeAg seroconversion, particularly in patients with adult-acquired HBV infection. Current guidelines recommend initiating antiviral therapy in HBeAg-positive patients who have ALT levels ???2 times the upper limit of normal (ULN) and HBV DNA levels ???20,000 IU/ml. Antiviral therapy is also recommended for HBeAg-positive patients with mildly elevated ALT levels (<2 ?? ULN) and HBV DNA levels ???20,000 IU/ml who have evidence of active necroinflammation and fibrosis, in the absence of another cause of liver injury, on histologic testing. In HBeAg-negative patients, the viral load for the threshold of treatment is lower, typically ???2,000 IU/ml. Regardless of HBeAg status, patients with decompensated cirrhosis and HBV DNA levels ???2,000 IU/ml are candidates for treatment. These patients should be started on oral nucleoside or nucleotide analog (NA) therapy and referred to a liver transplantation center. Other candidates for therapy include individuals receiving chemotherapy or immunosuppressive agents and HIV-coinfected individuals who are HBV seropositive, regardless of ALT and HBV DNA levels, as these individuals are at risk for reactivation of HBV. > > > [cut]--------------------------------------------------------------------------------> > Stopping antiviral therapy> Once antiviral treatment is initiated, patients should be monitored regularly to assess drug efficacy, safety, and tolerability, and also to detect disease flares and recognize the development of drug resistance; a further purpose for monitoring is to evaluate patient adherence [2]. HBV DNA and transaminase levels should be monitored at least every 3???6 months, while patients are receiving therapy with the oral agents. In addition, patients receiving peginterferon alfa should be monitored frequently for the development of side effects that might reduce tolerability including flu-like symptoms, depression, bone marrow suppression and neuropsychiatric disease. Peginterferon alfa-2a is administered for a fixed period of 1 year. Therapy is stopped prematurely only if intolerable side effects develop (these occur in <5% of patients). HBeAg, anti-HBe, and HBV DNA levels should be assessed at the time of discontinuation and every 6 months thereafter. > > The traditional end point of treatment with oral agents for patients with HBeAg-positive CHB is HBeAg seroconversion to anti-HBe in association with very low or undetectable serum HBV DNA levels [1???5]. Treatment is typically continued for an additional 6???12 months to reduce the likelihood of relapse. Some clinicians favor the long-term treatment of patients with cirrhosis with oral agents, even after HBeAg seroconversion, to avoid the risk of relapse. At this point, too few data exist to determine the optimal point at which to discontinue NAs. Extended or indefinite treatment with oral antiviral agents may be appropriate for cirrhotic patients. It is not known what the best treatment end point is for HBeAg-negative patients. However, if HBV DNA levels become undetectable and treatment is discontinued, relapse rates are high. In this case, current data support long-term treatment with oral antiviral agents. The relapse rate may be lower, albeit still substantial, if undetectable HBV DNA levels have been maintained for several years. In one study, two thirds of patients who discontinued adefovir after 4???5 years of therapy maintained normal ALT levels for an additional 15???20 months [21]. > > > --------------------------------------------------------------------------------

nwjk

回复 ybdn 的帖子

这样吃也为了省钱。主要是为了让药物少伤害我们的身体，还为了物尽其用。你想啊，病毒量已经<1000了，已经很少了，每天吃半片，应该也能抑制那么少的病毒吧，仍然吃那么多的药，岂不是太浪费，如果吃半片可以抑制病毒，吃一片不是也很伤害身体吗？很不值得吗？

思001

老大别自做主张，还是去你主治医生那请教一下吧

KG2010

嗯，想法不错，但要试的话还是要慎重考虑...

珊瑚一族

谁能自己冒险做这个实验？

幸福来临

你这是想让耐药早点来。