慢性B型與C型肝炎合併感染應用長效干擾素合併雷巴威林或全口服直接作用抗病毒藥物治療之世代性研究

Pegylated interferon combined with ribavirin or all-oral direct acting antivirals therapy for chronic hepatitis B and C dual-infection – A cohort study

葉明倫(Ming-Lun Yeh)

指導教授 ： 戴嘉言

高雄醫學大學/醫學院/醫學研究所博士班/博士(2019年)

摘要

Ｂ型肝炎與Ｃ型肝炎病毒感染為肝硬化與肝癌的主要原因。先前的研究已顯示Ｂ型肝炎與Ｃ型肝炎雙重感染病患會加速肝病進展且增加肝癌風險。長效型干擾素是全口服直接作用抗病毒藥物之前之Ｃ型肝炎感染標準治療。先前的研究已顯示長效型干擾素合併雷巴威林治療於Ｂ型肝炎與Ｃ型肝炎雙重感染病患之療效。儘管如此，關於使用長效型干擾素或全口服直接作用抗病毒藥物為基底之治療於Ｂ型肝炎與Ｃ型肝炎雙重感染病患仍有部份議題存在不確定性。我們的研究進一步證實以基礎病毒量與治療中反應為導向之治療方也可應用於此類病患；發現合併B型肝炎抗病毒藥物可以加強對Ｂ型肝炎e抗原陽性之雙重感染病患B型肝炎之控制；雙重感染病患在達到C型肝炎持續病毒反應後仍存在肝癌風險，停藥後六個月的胎兒蛋白可以作為預測因子；治療前B型肝炎病毒量可以預測接受干擾素治療後長期B型肝炎發作與表面抗原消失；全口服直接作用抗病毒藥物治療雙重感染病患可能導致B型肝炎發作，停藥後12個月累積風險約40%，但也有約10%病患可以產生B型肝炎表面抗原消失，治療前表面抗原濃度可以用來預測B型肝炎反應。

關鍵字

B型肝炎 ； Ｃ型肝炎 ； 雙重感染 ； 長效型干擾素 ； 全口服直接作用抗病毒藥物

並列摘要

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were the leading cause of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). Prior studies demonstrated the aggravation of liver disease and increased risk of HCC in these patients. The prior studies demonstrated the efficacy of PegIFN/RBV therapy for HBV/HCV dual infection. Although that, some issues regarding PegIFN or DAA based therapy for HBV/HCV dual infection remained uncertain. Our studies further demonstrated that the application of tailored regimen using baseline viral load and on-treatment response in these patients; combining HBV nucleot(s)ide analogs enhanced the HBV control in HBeAg-positive dual-infected patients; dual-infected patients remained at risk of hepatocellular carcinoma after HCV SVR and the 6 months post-treatment alpha fetoprotein level could be a predictor; pre-treatment HBV DNA level could predict long-term HBV flare and hepatitis B surface antigen (HBsAg) loss after PegIFN therapy; DAA therapy might induced HBV flare in dual-infected patients, the 12 months post-treatment cumulative risk was 40%, but around 10% of patients developed HBsAg loss, pre-treatment HBsAg titer could predict the HBV response after DAA therapy.

並列關鍵字

hepatitis B virus ； hepatitis C virus ； dual infection ； PegIFN ； DAA

參考文獻

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