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Emphasizing the Significance of the Role of HBV DNA Monitoring

来源：国际肝病作者：发布时间：2009-2-14阅读：1205
文章导读：In a chronic HBV carrier, chronic hepatitis B is defined by an elevated serum HBV DNA. The goal of chronic hepatitis B therapy is to prevent progression of liver disease to its complications. This can be achieved if HBV replication is durably abolished or significantly reduced. In an informative presentation, Professor Jean-Michel Pawlotsky emphasized the significance of the role of HBV DNA monitoring.
In a chronic HBV carrier, chronic hepatitis B is defined by an elevated serum HBV DNA. The goal of chronic hepatitis B therapy is to prevent progression of liver disease to its complications. This can be achieved if HBV replication is durably abolished or significantly reduced. In an informative presentation, Professor Jean-Michel Pawlotsky emphasized the significance of the role of HBV DNA monitoring. He said that antiviral treatment was currently recommended in patients with an HBV DNA titer above 2,000 IU/ml. HBV treatment monitoring is based on HBV DNA quantifications and ALT determinations every 3 to 6 months, whatever the HBe serostatus and antiviral treatment. In HBeAg-positive patients, treatment efficacy is witnessed by the loss of HBeAg, which may be followed by a seroconversion to anti-HBe antibodies. It is generally associated with a profound reduction of serum HBV DNA levels and normalization of aminotransferase activity. Ideally in HBe seroconverters, HBV DNA should be undetectable with a sensitive real-time PCR assay (lower limit of detection of the order 10 to 15 IU/ml) and aminotransferase activity should be normal. In HBeAg-positive patients with no HBe seroconversion and in HBeAg-negative patients, the goal of antiviral treatment is to achieve a profound and durable HBV DNA suppression. The HBV DNA level should be undetectable on treatment with a sensitive real-time PCR assay (lower limit of detection: 10 to 15 IU/ml).He also said if the HBV DNA level remained detectable after 48 weeks, a second antiviral compound with no cross-resistance with the first one must be added in order to prevent subsequent resistance. In the patients who have responded and have been compliant, resistance should be suspected if the HBV DNA level rises by more than 1 Log10 IU/ml above nadir in two consecutive samples taken one month part. The identification of selected amino acid substitutions known to be associated with resistance to the administered drug(s) by means of molecular testing can help guide treatment adaptation. Professor Pawlotsky also pointed out that consensus decisional algorithms would need to be established before systematic genotypic resistance testing can be recommended to adapt the treatment strategy to the resistance profile of the infecting viral strain.
编辑：yangxinxiang
内容标签：chronic hepatitis B
 

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