Chronic hepatitis B seriously endangers the health of our people, especially the occurrence of HCC, which brings huge economic burden and life threat to our people. 84% - 92% of HCC in China is related to chronic HBV infection. How to further reduce the risk of liver cancer is an urgent problem to be solved in clinical research and an important direction. Although NAs treatment can make patients achieve the negative transformation of virus, it can not effectively reduce the level of virus antigen, and it also lacks the ability to improve the immune clearance of virus. As a result, the incidence of liver cancer in patients with long-term NA treatment is still 4.5% - 10.5%, and the incidence of HCC in patients with hypoviremia in Na treatment is higher. In current clinical practice, nearly 1 / 3 of patients treated with NAs can not reach the detection line of highly sensitive reagent. It is an important measure to make the patients with hypoviremia and inactive low virus replication treated by NAs below the detection line of highly sensitive reagent and further reduce the risk of HCC. However, it is still not enough to minimize the risk of HCC to achieve a complete viral response only through NA treatment. The long-term follow-up showed that the incidence of HBsAg disappeared by only 2.0% - 0.0% regardless of the long-term treatment of HBsAg. Therefore, the most important measure to minimize the occurrence of HCC is to optimize the treatment of NA treated patients with low virus replication and inactive patients with low virus replication to achieve complete virus response and clinical cure. The purpose of this study is to explore the optimal treatment scheme for chronic hepatitis B NA treated patients with hypoviremia and natural low virus replication patients to significantly reduce the risk of HCC.
Chronic hepatitis B seriously endangers the health of our people, especially the occurrence of liver cancer, which brings huge economic burden and life threat to our people. 84% - 92% of hepatocellular carcinoma (HCC) in China is related to chronic HBV infection. How to further reduce the risk of liver cancer is an urgent problem to be solved in clinical research and an important direction. Although NAs treatment can make patients achieve the negative transformation of virus, it can not effectively reduce the level of virus antigen, and it also lacks the ability to improve the immune clearance of virus. As a result, the incidence of liver cancer in patients with long-term NA treatment is still 4.5% - 10.5%, and the incidence of HCC in patients with hypoviremia in Na treatment is higher. In current clinical practice, nearly 1 / 3 of patients treated with NAs can not reach the detection line of highly sensitive reagent. It is an important measure to make the patients with hypoviremia and inactive low virus replication treated by NAs below the detection line of highly sensitive reagent and further reduce the risk of HCC. However, it is still not enough to minimize the risk of HCC to achieve a complete viral response only through NA treatment. The long-term follow-up showed that the incidence of HBsAg disappeared by only 2.0% - 0.0% regardless of the long-term treatment of HBsAg. Therefore, the most important measure to minimize the occurrence of HCC is to optimize the treatment of NA treated patients with low virus replication and inactive patients with low virus replication to achieve complete virus response and clinical cure. The purpose of this study is to explore the optimal treatment scheme for chronic hepatitis B Na treated patients with hypoviremia and natural low virus replication patients to significantly reduce the risk of liver cancer.
Study Type
OBSERVATIONAL
Enrollment
1,200
PEG-IFN 180 or 135 micrograms, subcutaneously injected once a week, with a personalized treatment course of 24 weeks
Department of Hepatology Division 2, Beijing Ditan Hospital
Beijing, Beijing Municipality, China
RECRUITINGIncidence of HCC during the project study
Once the hepatitis attack (HBV DNA \> 2000 IU / ml, ALT \>40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
The negative conversion rate of HBV DNA after 48 weeks of treatment was optimized (below the detection line of highly sensitive detection reagent)
Once the hepatitis attack (HBV DNA \> 2000 IU / ml, ALT \>40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
The incidence of HBsAg disappearance during the study period;
Once the hepatitis attack (HBV DNA \>2000 IU / ml, ALT \> 40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
HBeAg seroconversion rate in HBeAg positive patients;
Once the hepatitis attack (HBV DNA \> 2000 IU / ml, ALT\> 40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
Incidence of chronic hepatitis B during the study period
Once the hepatitis attack (HBV DNA \> 2000 IU / ml, ALT \>40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
To study the incidence of complications such as cirrhotic ascites and upper gastrointestinal bleeding during long-term follow-up.
Once the hepatitis attack (HBV DNA \> 2000 IU / ml, ALT \> 40 U / L) is reached during the observation of inactive low virus replication HBsAg carriers, the researchers will communicate with the patients and take antiviral treatment, and continue to follow-up observation. All enrolled patients were included in the continuous follow-up cohort during the study period and after the end of the project.
Time frame: 48 weeks
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