CẬP NHẬT điều TRỊ VIÊM GAN b c

2018 AASLD – HBeAg (+) Noncirrhotic HBeAg-Positive Patients With CHB ALT ≤ ULN ALT > ULN but < x ULN ALT ≥ x ULN HBV DNA > 20,000 IU/mL  Monitor ALT and HBV DNA every 3-6 mos, HBeAg every 6-12 mos HBV DNA > 20,000 IU/mL  Exclude other causes of ALT elevation ̶̶ Treat if ALT elevation persists, especially if > 40 yrs of age  Evaluate fibrosis/inflammation ̶̶ Treat if ≥ F2/A3 HBV DNA > 20,000 IU/mL  Treat HBV DNA 2000-20,000 IU/mL may represent seroconversion  Monitor HBV DNA every 1-3 mos ̶̶ Treat if HBV DNA > 2000 IU/mL persists for > mos Terrault Hepatology 2018;67:1560 2018 AASLD – HBeAg (-) Noncirrhotic HBeAg-Negative Patients With CHB ALT ≤ ULN HBV DNA ≥ 2000 IU/mL  Monitor ALT and HBV DNA every mos for yr, then every mos HBV DNA < 2000 IU/mL  Monitor ALT and HBV DNA every 3-6 mos  Monitor HBsAg annually Terrault Hepatology 2018;67:1560 ALT > ULN but < x ULN Any Detectable HBV DNA  Exclude other causes of ALT elevation ̶̶ Treat if ALT elevation persists with HBV DNA ≥ 2000 IU/mL, especially if > 40 yrs of age  Evaluate fibrosis/inflammation ̶̶ Treat if ≥ F2/A3 ALT ≥ x ULN HBV DNA ≥ 2000 IU/mL  Treat HBV DNA < 2000 IU/mL  Exclude other causes of ALT elevation and evaluate fibrosis/inflammation ̶̶ Treat if ≥ F2/A3 HN GAN CHÂU ÂU 4-2019 HN GAN HOA KỲ 11/2019 CÁC CHỈ ĐIỂM MỚI CỦA NHIỄM HBV HBcrAg[1-4] HBV RNA[5]  Comprising HBeAg, HBcAg, and a core-related protein (p22cr) found in virion-like particles without HBV DNA  Serum HBV RNA: điểm theo dõi điều trị kháng HBV ‒ Products of the precore/core gene, share identical sequence of 149 amino acids  May reflect cccDNA levels  Quy trình chưa hồn tồn chuẩn hố  Correlations with HBV DNA, cccDNA: not consistent Wong Liver Int 2017;37:995 Hadziyannis Genes (Basel) 2018;9:469 Wong J Clin Microbiol 2007;45:3942 Kimura J Biol Chem 2005;280:21713 Liu Hepatology 2018;[Epub] HBcrAg HBcrAg HBcrAg  HBcrAg: correlates with intrahepatic cccDNA  Predict HBeAg) seroconversion  Predict persistent responses before and after cessation of nucleos(t)ide analogues, potential HBV reactivation and risk of hepatocellular carcinoma progression or recurrence  new potential therapeutic affect intrahepatic cccDNA are under development: the monitoring of HBcrAg might be useful to judge therapeutic effects NÊN MỞ RỘNG CHỈ ĐỊNH ĐIỀU TRỊ HAY KHÔNG? Should Patients With Immune-Tolerant CHB Be Treated? EPCLUSA ĐẠT SVR12 CAO TRÊN BN VIÊM GAN C ® KIỂU GEN 1,4,5,6 a % SVR12 điều trị EPCLUSA® (12 tuần/ASTRAL-1) 100 98% % bệnh nhân 80 99% 98% n=72/73 Chưa điều trị 99% 100% 97% 100% 60 40 20 n=251/255 Khơng có xơ gan Có xơ gan n=214/218 GT1: đạt SVR 98% a Feld JJ, et al N Engl J Med 2015; 373 (27): 2599-2607 n=109/110 Đã điều trị n=116/116 GT4 n=34/35 GT5 n=41/41 GT6 MẠN TÍNH EPCLUSA® + RBV /12 w/ BN XƠ GAN MẤT BÙ 100 94% 96% Đánh giá chung n=82/87 SVR12 n=65/68 b 94% 100% 100% 85% 80 % bệnh nhân 100% 60 40 20 GT GT 1a n=51/54 b GT 1b n=14/14 SVR12 tiêu chí định nghĩa HCV RNA