Stanzione Maria, Stornaiuolo Gianfranca, Rizzo Viviana, Pontarelli Agostina, Gaeta Giovanni Battista
Infectious Diseases and Viral Hepatitis Unit, Department of Internal and Specialistic Medicine, Second University of Naples, Italy.
Infez Med. 2016 Jun 1;24(2):144-6.
Hepatitis B virus (HBV) surface antigen (HBsAg) seroconversion to anti-HBs antibody is the best final objective for all available chronic hepatitis B (CHB) treatments. Unfortunately, this goal is rarely achieved with the currently applied therapeutic approaches. Here we describe the case of an anti-HBe-positive CHB patient who was successfully treated with a particular therapeutic schedule. The patient was initially treated with lamivudine (LAM) for nine years. Breakthrough was observed after eight years of LAM therapy. HBV-DNA was 3x10E4 IU/mL and LAM resistance mutations were present. Subcutaneous pegylated interferon (PEG-IFN) alfa 2a, 180 mcg/week, was added to LAM and after 4 weeks LAM was discontinued and PEG-IFN alone was continued up to week 52. HBV-DNA became undetectable at week 4 of therapy; serum HBsAg started to decline from week 4 and became undetectable at week 36, with the subsequent appearance of anti-HBs antibodies. IL28-B was genotyped at the polymorphic site rs12979860 and the CC allele was detected. Rescue therapy with Peg-IFN may be an option for selected patients with resistance to nucleos(t)ide analogues.
乙肝病毒（HBV）表面抗原（HBsAg）血清学转换为抗-HBs抗体是所有现有慢性乙型肝炎（CHB）治疗的最佳最终目标。不幸的是，目前应用的治疗方法很少能实现这一目标。在此，我们描述了一例抗-HBe阳性的CHB患者通过特定治疗方案成功治愈的病例。该患者最初接受拉米夫定（LAM）治疗九年。拉米夫定治疗八年后出现病毒突破。HBV-DNA为3×10⁴IU/mL，且存在拉米夫定耐药突变。在拉米夫定基础上加用皮下注射聚乙二醇干扰素（PEG-IFN）α 2a，180 mcg/周，4周后停用拉米夫定，仅继续使用PEG-IFN至第52周。治疗第4周时HBV-DNA检测不到；血清HBsAg从第4周开始下降，第36周时检测不到，随后出现抗-HBs抗体。对rs12979860多态性位点进行IL28-B基因分型，检测到CC等位基因。对于选定的对核苷（酸）类似物耐药的患者，聚乙二醇干扰素挽救治疗可能是一种选择。
