Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia.
Liver Int. 2013 Sep;33(8):1203-10. doi: 10.1111/liv.12154. Epub 2013 Mar 24.
Hepatitis B reactivation in patients receiving immunosuppressive therapy or chemotherapy may be associated with acute hepatitis, liver failure and/or death.
To audit the efficacy of entecavir as compared to lamivudine for the prophylaxis of HBV reactivation in patients with haematological disease receiving immunosuppression or chemotherapy.
Patients treated for haematological disease with pretreatment serological evidence of chronic hepatitis B (CHB) (HBV surface antigen, HBsAg positive) or resolved HBV infection (HBsAg negative but HBV core antibody positive) are included in this study. Patients received lamivudine 100 mg or entecavir 0.5 mg daily. Hepatitis B serology, HBV DNA and ALT were audited at baseline, 6 months, year 1, 2 and 3. HBV reactivation was defined as a 1 log increase in HBV DNA from baseline or reversion to sAg positivity. The occurrence of jaundice, symptomatic hepatitis, liver failure or death were audited.
Of the 40 patients included in the study, 65% (4 CHB and 22 resolved HBV) received entecavir and 35% (11 CHB and 3 resolved HBV) received lamivudine. One patient with resolved HBV experienced HBV seroreversion related to premature cessation of entecavir. Eight patients with CHB (two from entecavir group and six from lamivudine group) had detectable HBVDNA levels at baseline; one case of HBV reactivation related to probable lamivudine resistance was identified. No HBV related deaths occurred.
Lamivudine and entecavir are both efficacious in the prophylaxis of hepatitis B reactivation. Entecavir should be used in preference to lamivudine in patients CHB with detectable baseline HBV DNA levels.
接受免疫抑制治疗或化疗的患者乙型肝炎病毒（HBV）再激活可能导致急性肝炎、肝衰竭和/或死亡。
评估恩替卡韦与拉米夫定预防接受免疫抑制或化疗的血液系统疾病患者 HBV 再激活的疗效。
本研究纳入了经预处理血清学检查证实患有慢性乙型肝炎（HBV）（HBV 表面抗原，HBsAg 阳性）或 HBV 感染已清除（HBsAg 阴性但 HBV 核心抗体阳性）的血液系统疾病患者。患者接受拉米夫定 100mg 或恩替卡韦 0.5mg 每日 1 次治疗。基线、6 个月、1 年、2 年和 3 年时检测 HBV 血清学、HBV DNA 和丙氨酸氨基转移酶（ALT）。HBV 再激活定义为 HBV DNA 较基线水平升高 1 对数或 HBsAg 转为阳性。检测黄疸、症状性肝炎、肝衰竭或死亡的发生情况。
本研究共纳入 40 例患者，其中 65%（4 例 HBV 和 22 例 HBV 已清除）接受恩替卡韦治疗，35%（11 例 HBV 和 3 例 HBV 已清除）接受拉米夫定治疗。1 例 HBV 已清除患者因过早停用恩替卡韦而出现 HBV 血清学逆转。8 例 HBV 患者（恩替卡韦组 2 例，拉米夫定组 6 例）基线时 HBV DNA 可检测，发现 1 例与可能的拉米夫定耐药相关的 HBV 再激活病例。无 HBV 相关死亡发生。
拉米夫定和恩替卡韦均能有效预防 HBV 再激活。对于基线 HBV DNA 可检测的 HBV 患者，应优先使用恩替卡韦而非拉米夫定。
