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Evaluation of potent antiviral therapy in patients with chronic hepatitis B.

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Written by   41
11 months ago

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In the treatment of chronic hepatitis B (CHB)

targeted; life expectancy of patients

prolongation and long-term illness

especially the complications

Hepatocellular Carcinoma (HSC)

is protection. Among other targets

prevention of mother-to-child transmission, HBV

reactivation and HBV-related extrahepatic

events are prevented. The most in treatment

important endpoint is HBV DNA suppression.

providing and long-term

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probability of reaching these goals.

The time of initiation of treatment is important. This

the stage of the disease to determine the time and

patient age is taken into account. in the advanced

HBV first target in patients with cirrhosis

suppression of the second target is the development of HCC.

is to prevent. Final choice of treatment

one of the guides 2019 European

Association for the Study of the Liver (EASL),

strong and resistance barrier as the first choice

Entecavir (ETV), Tenofovir

disoproxil (TDF) or Tenofovir alafenamide

long-term application of (TAF) treatments

2 ETV since 2006, TDF

in our country since 2008.

are potent antivirals.

In this study, in our outpatient

with regular follow-up, good drug compliance

In patients who started ETV or TDF treatment,

virological, serological and

biochemically long term

evaluation of its effectiveness

intended.

Method

Study A retrospective clinical

The study was conducted between 2007 and 2015.

Infection in a tertiary hospital

Diseases and Clinical Microbiology

was done in the clinic. Erciyes for work

From the Ethics Committee of the University of Medicine

(No. 96681246) has been approved.

In the study, those diagnosed with CHB,

111 who had not received prior oral antiviral therapy

patients were included (54 in the TDF group, ETV

57 in the group).

Inclusion criteria for the study; 18

age and above, under 70 years of age, for longer than six months

HBsAg positivity at the beginning of treatment

HBV DNA 104 copies/ml, liver

Histology Ishak stage two and above histology

with an activity index (HAI) of below or above,

TDF or ETV for more than a month

used patients were included. of patients

After starting ETV/TDF therapy

follow-up times were recorded.

Exclusion Criteria in the Study;

Autoimmunity, metabolic liver disease,

decompensated cirrhotic patients, pregnancy, chronic

kidney failure, heart failure and COPD

Patients with such conditions were excluded.

Treatment response in patients

in its evaluation; For viral suppression

HBV DNA negative, biochemical

In response, ALT reduction was also checked.

In addition, changes in hepatitis serologies

was also recorded.

HBV DNA levels “Cobas

TaqManTM 48” (Roche Laboratories,

Germany) was measured with the Real-Time PCR system.

HBV DNA negative value <100 copies/ml

was accepted as ALT level biochemical

determined by the method. The lower limit is 40 IU/L

determined. As a serological indicator, HBsAg,

antiHBs, HBeAg, antiHBe positive/negative

changes are saved.

in laboratory follow-up

ratings 6. 12, 24, 36, 48, 60 and 72.

was done at monthly follow-ups.

Oral antiviral drug changes

was recorded. Patients undergoing medication changes

not working after change

removed.

Before starting treatment, patients

liver biopsy materials Ishak score

4 Patients' baseline Histological

Activity Index (HAI) and fibrosis (stage)

scores were recorded.

The diagnosis of cirrhotic patients is clinical,

biochemical (Transaminases, albumin

level, PT, hypersplenism) and histological

According to the stage (Ishak stage 4 and above)

determined.

Statistical analysis

SPSS for data evaluation

statistical package program for windows 20.0

used. Regarding the measurable variable

data mean ± standard deviation and percentage

presented with. Categorical data

Chi-square test was used for comparison.

Comparison of non-categorical data

Mann Whitney U test was used for p<0.05

values ​​that are statistically significant

accepted.

Results

The patients included in the study

demographic characteristics are listed in Table 1.

Accordingly, age, gender, IFN use

history, ALT level, histology

statistical difference between evaluations

not seen. Initial HBV DNA of patients

level (p=0.02), HBeAg positivity rate TDF

group (p=0.05), treatment follow-up was higher.

duration was higher in the ETV group.

(p=0.04).

99 of the patients included in the study

(89%) liver biopsy was performed and 12

(11%) hemangioma and coagulation

biopsy for reasons such as

determined that it could not be done.

Virological response

Patients in both groups

HBV DNA levels during follow-up Table

It was shown in 2. Initial HBV DNA value

Although higher in the TDF group,

HBV DNA suppression at 6 and 12 months

In ETV group compared to TDF group

statistically significantly more

found to be excessive (p=0.001; p=0.03).

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