Reijnders Jurriën G P, Pas Suzan D, Schutten Martin, de Man Robert A, Janssen Harry L A
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 204, 3015 CE Rotterdam, The Netherlands.
J Hepatol. 2009 Apr;50(4):674-83. doi: 10.1016/j.jhep.2008.10.033. Epub 2008 Dec 29.
BACKGROUND/AIMS: We investigated the efficacy of entecavir in lamivudine-experienced and -naïve patients with persistently high HBV DNA during adefovir treatment.
Fourteen chronic hepatitis B patients (57% lamivudine-experienced) with a viral load above 5log(10)copies/mL after 12months of adefovir therapy and thereafter were treated with entecavir 1mg daily.
During a median follow-up of 15months (range: 8-23months) one of six lamivudine-naïve and none of the eight lamivudine-experienced patients achieved undetectable HBV DNA (<373copies/mL). HBeAg loss occurred in none of the subjects. Two lamivudine-experienced patients demonstrated the rtM204I mutation; no other entecavir-resistant substitutions were detected (rtI169, rtT184, rtS202, and rtM250). Two of three patients with genotypic adefovir resistance at baseline demonstrated a rapid virologic response to entecavir, but undetectable HBV DNA was not achieved. To attain a better antiviral response the dosage of entecavir was increased to 2mg daily in two patients, resulting in further viral load decline for both of them.
Entecavir monotherapy dosed at 1mg resulted in a slow reduction of viral load in both lamivudine-experienced and -naïve patients with persistently high HBV DNA during adefovir therapy. Increasing the dosage of entecavir led to further HBV DNA decline.
背景/目的：我们研究了恩替卡韦对在阿德福韦治疗期间乙肝病毒（HBV）DNA持续高水平的拉米夫定经治和初治患者的疗效。
14例慢性乙型肝炎患者（57%为拉米夫定经治患者），在阿德福韦治疗12个月后病毒载量高于5log(10)拷贝/毫升，此后接受每日1毫克恩替卡韦治疗。
在中位随访15个月（范围：8 - 23个月）期间，6例拉米夫定初治患者中有1例、8例拉米夫定经治患者中无1例实现HBV DNA检测不到（<373拷贝/毫升）。所有受试者均未发生HBeAg血清学转换。2例拉米夫定经治患者出现rtM204I突变；未检测到其他恩替卡韦耐药替代位点（rtI169、rtT184、rtS202和rtM250）。3例基线存在阿德福韦基因型耐药的患者中有2例对恩替卡韦表现出快速病毒学应答，但未实现HBV DNA检测不到。为获得更好的抗病毒应答反应，2例患者将恩替卡韦剂量增加至每日2毫克，二者病毒载量均进一步下降。
对于在阿德福韦治疗期间HBV DNA持续高水平的拉米夫定经治和初治患者，每日1毫克剂量的恩替卡韦单药治疗导致病毒载量缓慢下降。增加恩替卡韦剂量可使HBV DNA进一步下降。
