Liu Yun 51 years old this year, looking for me to hepatitis B over three years ago. At that time Liu Yun transaminase repeated fluctuations
Liu Yun 51 years old this year, looking for me to hepatitis B over three years ago. At that time Liu Yun transaminase repeated fluctuations in about 100, small Sanyang, quantitative HBVDNA is seven times of ten copies, taking into account the small Sanyang hepatitis treated with interferon after the recurrence rate is very high, I suggest that he preferred domestic entecavir long-term treatment. Liu Yun is not willing to long-term medication, want to try interferon treatment. The use of interferon after treatment for three months, HBVDNA quantitative motionless, Liu Yun had to start taking domestic entecavir. After three months of taking the drug to make Liu Yun very happy, HBVDNA quantitative quickly decreased from the ten to the second party of the three party, the virus decreased by ten thousand times in the three months! After three months of examination, the HBVDNA was quantitatively reduced to a factor of ten for the two time. After the results of the examination is very worried about Liu Yun: the virus decreased to ten of the two party will no longer fall! Liu Yun is very worried about the risk of drug resistance, other doctors also told him that if taking entecavir for one year the amount of virus is not negative to alert resistance, we must add adefovir dipivoxil.
Liu Yun's source of drugs is regular, Liu Yun medication is regular, half an hour before going to bed for medication, medication two small stomach before and after the time, he did not drink and use glucocorticoids. And he inspected once every three months, the quantitative HBVDNA has been stable at two square ten, no signs of increased, more importantly, his HBsAg quantification has been decreased slowly, so I judge Liu Yun and no entecavir resistance, advised him to continue taking entecavir treatment. Single drug.
Today is August 22, 2014, Liu Yun has been taking entecavir in two years and four months, the inspection results made Liu Yun overjoyed: all the normal liver function, HBVDNA less than 100 copies, after 28 months of time, the amount of virus was negative!
Liu Yun's situation is not uncommon, taking entecavir Kaweman a year still not the amount of virus negative accounts for about 10%, this situation can be called "the poor effect of entecavir. Drug resistance or poor effect, the need for a good analysis of clinicians. All nucleoside (acid) drugs may have drug resistance, but entecavir is now recognized worldwide as first-line drugs, antiviral effect of strong resistance rate is very low, as long as no drinking, no first used lamivudine or telbivudine and entecavir with little resistance, resistance six years the incidence rate of only 1.2%. If a clear judgment is entecavir effect is poor, as long as continue taking entecavir monotherapy can extend the treatment to one and a half years or 2--3 years most of the virus will be negative.
Entecavir resistant virus has not negative why not? Someone explained: TC (nucleoside or nucleotide) into the liver cells to inhibit the virus, liver cells in the phosphatase activity type into TC (three nucleotide), some innate phosphatase is relatively small, so the virus will be very slow. To do care about the amount of virus has not negative patients, can consider changing with entecavir two tablets (1 mg) or tenofovir treatment, the amount of virus negative after 3--6 months of consolidation therapy, can change back to entecavir monotherapy a treatment.
For the previous short time used lamivudine or telbivudine patients, if taking entecavir for one year the amount of virus or virus has not yet been negative; decline after rising, or E and S antigens in patients with no quantitative decline, need to consider whether there is entecavir resistance, the need to do a mutation detection once found, the need for timely treatment of drug resistance.