Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8677, Japan.
Int J Med Sci. 2013;10(6):647-52. doi: 10.7150/ijms.5904. Epub 2013 Apr 1.
Nucleos(t)ide analogues (NAs) lead to viral suppression and undetectable hepatitis B virus (HBV) DNA in some individuals infected with HBV, but the rate of virological rebound has been unknown in such patients. We examined the prevalence of virological rebound of HBV DNA among NA-treated patients with undetectable HBV DNA. We retrospectively analyzed 303 consecutive patients [158 entecavir (ETV)- and 145 lamivudine (LAM)-treated] who achieved HBV DNA negativity, defined as HBV DNA < 3.7 log IU/mL for at least 3 months. They were followed up and their features, including their rates of viral breakthrough, were determined. Viral rebound after HBV DNA negativity was not observed in the ETV-group. Viral rebound after HBV DNA negativity occurred in 38.7% of 62 HBe antigen-positive patients in the LAM-group. On multivariate analysis, age was an independent factor for viral breakthrough among these patients (P = 0.035). Viral rebound after HBV DNA negativity occurred in 29.1% of 79 HBe antigen-negative patients in the LAM-group. Differently from LAM, ETV could inhibit HBV replication once HBV DNA negativity was achieved. In contrast, LAM could not inhibit HBV replication even if HBV negativity was achieved in the early phase. Attention should be paid to these features in clinical practice.
核苷（酸）类似物 (NAs) 可使部分乙型肝炎病毒 (HBV) 感染者的病毒得到抑制，HBV DNA 检测不到，但此类患者的病毒学反弹率尚不清楚。我们检测了 NAs 治疗后 HBV DNA 检测不到的患者中 HBV DNA 病毒学反弹的发生率。我们回顾性分析了 303 例连续患者[158 例恩替卡韦 (ETV) 和 145 例拉米夫定 (LAM) 治疗]，他们的 HBV DNA 至少连续 3 个月阴性，定义为 HBV DNA < 3.7 log IU/mL。对他们进行了随访，确定了他们的特征，包括病毒突破率。在 ETV 组中未观察到 HBV DNA 阴性后病毒反弹。在 LAM 组中，62 例 HBe 抗原阳性患者中有 38.7%出现 HBV DNA 阴性后病毒反弹。多变量分析显示，年龄是这些患者病毒突破的独立因素 (P = 0.035)。在 LAM 组中，79 例 HBe 抗原阴性患者中有 29.1%出现 HBV DNA 阴性后病毒反弹。与 LAM 不同，一旦 HBV DNA 阴性，ETV 可抑制 HBV 复制。相反，即使在早期阶段 HBV 阴性，LAM 也不能抑制 HBV 复制。在临床实践中应注意这些特点。
