Department of Digestion, Chengdu Military General Hospital, Sichuan, People's Republic of China.
Virol J. 2011 Aug 4;8:388. doi: 10.1186/1743-422X-8-388.
Currently, there is no consensus on the retreatment recommendation of chronic hepatitis B (CHB) patients with viral rebound after cessation of treatment. In the search of reasonable treatment, we compared the efficacy and safety of adefovir (ADV) plus lamivudine (LAM) and LAM alone for the retreatment of patients with viral relapse but without genotypic resistance after cessation of LAM.
This is a prospective controlled study, and a total of 53 hepatitis B e antigen (HBeAg)-positive patients with viral rebound but without resistance were received either LAM plus ADV or LAM alone treatment.
After 1-year treatment, more patients who received LAM plus ADV than those who received LAM alone had ALT normalization (84% versus 53.6%, P = 0.018) or HBV DNA levels below 1000 copies/mL (80% versus 42.9%, P < 0.006). Seven patients receiving LAM plus ADV had HBeAg seroconversion, as compared with 0 in patients receiving ALM alone (28% versus 0%, P = 0.003). During 1-year retreatment, five patients receiving LAM alone had virological breakthrough and all of them had LAM resistance strains (rtM204V/I), while no LAM- or ADV- associated resistance strains were detected in patients receiving LAM plus ADV. All patients receiving LAM plus ADV were well tolerated, and no serious side effects were noted.
Patients treated with LAM plus ADV exhibited significantly greater virological, biochemical and serological responses compared with LAM alone. These data suggested that combination of LAM plus ADV would be a good option for the retreatment of CHB patients with viral relapse after cessation of LAM.
目前，对于停止治疗后发生病毒反弹的慢性乙型肝炎（CHB）患者，尚无关于再治疗推荐的共识。在寻找合理的治疗方法时，我们比较了阿德福韦酯（ADV）加拉米夫定（LAM）与 LAM 单药治疗 LAM 停药后病毒复发但无基因型耐药患者的疗效和安全性。
这是一项前瞻性对照研究，共纳入 53 例 HBeAg 阳性、病毒反弹但无耐药的患者，分别接受 LAM 加 ADV 或 LAM 单药治疗。
治疗 1 年后，接受 LAM 加 ADV 治疗的患者中，ALT 复常（84%比 53.6%，P=0.018）或 HBV DNA 水平<1000 拷贝/ml（80%比 42.9%，P<0.006）的患者多于接受 LAM 单药治疗的患者。接受 LAM 加 ADV 治疗的患者中有 7 例发生 HBeAg 血清学转换，而接受 LAM 单药治疗的患者中无一例发生（28%比 0%，P=0.003）。在 1 年的再治疗期间，5 例接受 LAM 单药治疗的患者发生病毒学突破，且均存在 LAM 耐药株（rtM204V/I），而接受 LAM 加 ADV 治疗的患者未检测到 LAM 或 ADV 相关耐药株。所有接受 LAM 加 ADV 治疗的患者均耐受良好，未出现严重不良反应。
与 LAM 单药治疗相比，LAM 加 ADV 治疗的患者病毒学、生化学和血清学应答显著更优。这些数据表明，对于 LAM 停药后病毒复发的 CHB 患者，LAM 加 ADV 联合治疗可能是一种较好的选择。
