Emphasizing 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 today’s presentation, Professor Jean-Michel Pawlotsky emphasized the significance of the role of HBV-DNA mornitoring. He said that antiviral treatment is 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 with 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 remains 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 Jean-Michel Pawlotsky also pointed out that consensus decisional algorithms will 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.

慢性乙型肝炎治疗的目标为防止失代偿肝病的发生，这一目标可以通过清除或有效抑制病毒来达到。Jean-Michel Pawlotsky教授指出乙型肝炎病毒的监测包括：每3-6个月检测HBV-DNA载量、血清ALT水平以及监测抗病毒治疗情况。对于HBeAg阳性的患者，由于血清HBV-DNA水平受到抑制而出现e抗原消失或血清转换为治疗有效的表现。而对于没有出现e抗原血清转换的HBeAg阳性患者或HBeAg阴性的患者抗病毒治疗的目标则为持续抑制病毒在体内的复制。对于治疗48周后HBV-DNA仍未阴转的患者则需考虑抗病毒药物的联合应用，同时要监测治疗的耐药情况。因此对慢性乙型肝炎全方位的监测对于治疗具有非常重要的意义！