patient, male, visited the hospital in August 2012, at the time of 32 years old. The patient found that hepatitis B had a strong three positive effect for more than ten years and the aminotransferase was slightly increased for about five years. Because grandma and dad both died of hepatitis B-related cirrhosis , the patient is very afraid of hepatitis B.
patients started antiviral treatment five years ago (2007) and used lamivudine . They found drug resistance two years later. Later, lamivudine combined with adefovir ester was still resistant, and entecavir combined with adefovir was still resistant. When he went to Shanghai for treatment, experts suggested trying tebivudine combined with adefovir ester. It worked very well at the beginning, but resistance occurred a year later. Drug resistance sites show that lamivudine, tebivudine, entecavir and adefovir are all resistant! !
All four drugs are resistant to drugs. What should I do?
patient came to consult me after someone introduced me and asked me sadly with the examination sheet: "Doctor Wang, all the four oral drugs for treating chronic hepatitis B are resistant. Can I still save me?" I said to him with certainty: "The hepatitis B virus is resistant. After careful analysis and reasonable use of the drug, you can get good results, and there is no need to worry."
The patient's surface antigen was accurately measured at that time, 8705.125 IU/ml, HBeAg quantification was 980 S/CO, alanine aminotransferase 65, and color ultrasound showed that there was no obvious abnormality in the liver, gallbladder, spleen and pancreas. Analysis of the reasons: On the basis of obvious immune tolerance and weak liver inflammatory response, lamivudine, the highest drug resistance rate, was used, which triggered a series of drug resistance.
I suggested that he stop the medication and observe, and stop both tebivudine and adefovir. The patient asked me in surprise: "Can you stop the medication? Many doctors told me that stopping the medication at will will induce an acute attack of hepatitis, which will be fatal if it is severe!" I explained patiently: "Your liver foundation is relatively good, and there is no obvious sign of liver fibrosis at present. Moreover, your virus volume has rebounded from the power of 3 to the power of 6. If you continue to take the medication in this case, the amount of virus will increase, and the virus resistance will be more complicated. You stop the medication under the guidance of the doctor and draw blood on time for re-examination, and there will be no major problems." After
, the patient's liver function is checked every 2-3 weeks. After three months, the aminotransferase begins to increase significantly, from the initial 65 to about 160. I suggest that he should not be anxious and continue to have a review every six months. The aminotransferase gradually increases from around 160 to 420. At this time, the antiviral treatment of two tablets of entecavir (1 mg) + 10 mg of adefovir.
After that, the patient's antiviral treatment path was "smooth" and three months later, HBVDNA quantitative <100>, tenofovir and , and treated with single agent. The quantification of hepatitis B surface antigen has steadily decreased year by year. After four years, hepatitis B clinical cure —hepatitis B surface antigen turned negative (HBsAg quantification <0.05>
, and gradually we have some experiences. The process of antiviral treatment is actually a process of the patient's HBVDNA replication ability, his own immune response to clearing hepatitis B virus, and antiviral drugs.
resistance is more common in patients with hepatitis B, who have low aminotransferase and high HBVDNA quantification. At this time, the patient's immune tolerance is still relatively obvious, and the immune response of self-clearing hepatitis B virus is not strong. Finding ways to activate the patient's immune response to clearing the virus by themselves. On this basis, selecting appropriate drugs is the key to the successful treatment of drug-resistant virus strains.
We currently have good drugs such as entecavir, tenofovir, and propofol. As long as we analyze carefully and respond reasonably, we can achieve good results in drug resistance. Hepatitis B can be defeated!
Comprehensive Outpatient Department of Shangrao Second People's Hospital, Jiangxi Province Wang Chunxi
