Nucleos(t)ide Analogues Only Induce Temporary Hepatitis B e Antigen Seroconversion in Most Patients With Chronic Hepatitis B

Reijnders, Jurriën G.P.; Perquin, Moniek; Zhang, Ning‐Ping; Hansen, Bettina E.; Janssen, Harry L.A.

doi:10.1053/j.gastro.2010.03.059

Cited by 167 publications

(151 citation statements)

References 33 publications

Supporting

Mentioning

139

Contrasting

Order By: Relevance

“…HBeAg-positive chronic HBV infection treatment cannot maintain sustained viral suppression after stopping treatment [9]. However, when consolidation treatment [2,4,5,8] was performed before termination of lamivudine treatment or when patients were young [4][5][6][7][8], the rate of virologic relapse was dramatically reduced.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Antiviral Therapy for Chronic Hepatitis B Virus Infection: Is Continuous Treatment Needed?

Lee¹

2014

GHOA

View full text Add to dashboard Cite

AbbreviationsNA: Nucleos(T)Ide Analogue; HBV: Hepatitis B Virus; cccDNA: covalently closed circular DNA IntroductionLong-term usage of oral antiviral is highly effective in treating chronic hepatitis B virus (HBV) infection and can effectively suppress HBV proliferation which may prevent the progression of liver fibrosis and the development of HCC after long term use of NAs but cannot completely eradicate the virus. Furthermore, the safety of long-term usage of antivirals is still a concern that needs to be assessed and the increasing cost of antiviral treatments can be a serious financial burden. It is still unclear how long antiviral treatment needs to be continued and how to determine when discontinuation of the treatment is appropriate. The presence of covalently closed circular DNA (cccDNA) in hepatocytes correlates to immune activity and is used as a predictive factor to evaluate sustained viral suppression after termination of antiviral treatment [1]. Unlike pegylated interferon, oral antivirals do not have direct immunomodulatory effects and only temporarily induce a modest increase in immune function. Therefore, oral antiviral treatments are unlikely to provide continued viral suppression after termination. Discussion HBeAg-positive chronic HBV infectionPatients that reach sustained viral suppression (HBV DNA negativity and HBeAg loss or seroconversion) with lamivudine usage show a virologic relapse rate of 15.9-48%, 29-50%, 54-55.7%, and 44-64.8% 1, 2, 3, and 4 years after discontinuation of lamivudine respectively [2][3][4][5][6][7][8]. A considerable number of patients that undergo HBeAg seroconversion upon oral antiviral AbstractPotent nucleos(t)ide analogues (NAs) have improved patient prognosis via suppression of viral load, HBeAg seroconversion and in some cases, HBsAg seroconversion. However, the duration and end point of NA treatment are still debatable. Current international guidelines recommend that discontinuation of NA treatment can be considered when HBeAg seroconversion and undetectable HBV DNA status is maintained for at least 6-12 months for HBeAg-positive patients and undetectable HBV DNA status on 3 separate occasions 6 months apart for HBeAgnegative patients if they have been treated for at least 2 years. Durability of NA, particularly after off-treatment, remains uncertain. A proportion of patients who discontinue NA therapy after HBeAg seroconversion may require retreatment if sustained serological and/or virological response fails and high off-treatment virological relapse can develop in HBeAg-negative patients. Therefore, NA treatment may be continued until HBsAg clearance with or without antibodies to HBsAg, particularly in patients with severe fibrosis or cirrhosis.

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, if treatment is stopped after HBeAg seroconversion, as suggested by the guidelines, the rate of sustained viral suppression maintenance is low. Therefore, HBeAg seroconversion alone is insufficient as a determining factor for discontinuing antiviral treatments [9].…”

Section: Discussionmentioning

confidence: 99%

Oral Antiviral Therapy for Chronic Hepatitis B Virus Infection: Is Continuous Treatment Needed?

Lee¹

2014

GHOA

View full text Add to dashboard Cite

show abstract

“…Other drugs such as tenofovir and adefovir dipivoxil can show beneficial associations with HAART in the treatment of lamivudine-resistant hepatitis B (Benhamou et al, 2001;Perillo et al, 2000). There are potentially more effective drugs or combination therapies, which can reduce intrahepatic covalently closed circular DNA (cccDNA) effectively in chronic B hepatitis patients (Kumar et al, 2011;Reijnders et al, 2010;Shinkai et al, 2006;Sung et al, 2005). Other studies report virus clearance by parvovirus B19 in HIV-infected people after HAART application.…”

Section: Antiretroviral Drugs and Viral Agentsmentioning

confidence: 99%

Activity of antiretroviral drugs in human infections by opportunistic agents

Demarchi

Cardozo

Aristides

et al. 2012

Braz. J. Pharm. Sci.

View full text Add to dashboard Cite

Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.
A terapia HAART (terapia antirretroviral altamente ativa) é usada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e demonstrou diminuição significativa de infecções oportunistas, tais como as causadas por vírus, fungos, protozoários e bactérias. O uso da HAART está associado com a reconstituição imunológica e diminuição na prevalência de candidíase oral. A terapia antirretroviral beneficia pacientes co-infectados pelo HIV, vírus herpes humano 8 (HHV-8), vírus Epstein-Barr (EBV), vírus da hepatite B (HBV), parvovírus B19 e citomegalovírus (CMV). A HAART também apresentou redução significativa da incidência e modificou as características da bacteremia por agentes etiológicos, tais como Staphylococcus aureus, espécies não-tifóides de Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis. A HAART é capaz de modificar significativamente a história natural da criptosporidiose e microsporidiose. HAART pode efetivamente restaurar a imunidade da mucosa, levando à erradicação de Cryptosporidium parvum. Semelhante restauração da resposta imune ocorre em infecções por Toxoplasma gondii. O declínio na incidência de co-infecção leishmaniose visceral/HIV pode ser observada após a introdução da terapia com inibidores da protease. Os resultados atuais são altamente relevantes para a medicina clínica e podem proporcionar diminuição no número de prescrições medicamentosas e, consequentemente, melhor qualidade de vida para pacientes com doenças oportunistas

show abstract

“…Continuation of therapy until HBsAg seroconversion is advisable. [42] Patients with HBeAg-negative chronic hepatitis B and those with cirrhosis require lifelong treatment with NUCs.…”

Section: Nucsmentioning

confidence: 99%