干扰素作用下乙型肝炎病毒变异的体外实验研究

乙型肝炎病毒（HBV）变异是导致HBV持续性感染的一个重要原因，研究表明，干扰素（IFN）临床治疗过程中，HBV突变株被检测的概率增加，但突变株产生的机制目前存在着不同意见。通过体外研究IFN作用下HBV突变现象将有助于揭示IFN直接分子作用在HBV突变株产生过程中的意义，为探讨IFN致HBV C基因变异的多重机制提供科学的实验依据。     

肝细胞癌肿瘤抑制基因p53过度表达及点突变的研究

目的检测重庆地区肝细胞癌 p53突变发生率,并进一步探讨 p53突变与肝细胞癌临床病理及相关危险因素的关系.方法应用一种敏感的 ARF 免疫组化和 PCR、银染 PCR-SSCP 方法检测本地区38例肝细胞癌(HCC)组织中肿瘤抑制基因p53的过度表达及点突变.结果 16例有P53蛋白过度表达(41.2%),7例有 p53基因249位密码子点突变(18.4%),2例249位密码子外第7外显子点突变.9例 p53基因有突变的肝癌中8例 P53蛋白阳性,两者符合率为88.9%.p53基因蛋白过度表达和点突变与 HCC 分化和转移有关.本组 HCC p53基因突变率与该地区黄曲霉素(AFB1)含量及乙型肝炎病毒(HBV)感染分布一致.结论该结果提示 p53基因突变与 AFB1和 HBV 等环境因素的协同作用有关,其中 AFB1主要与 p53基因249位密码子特异型突变有关,而 HBV 可能在散发型突变中发挥重要作用.     

干扰素单用及联合拉米夫定、阿德福韦、胸腺肽α1治疗e抗原阳性、C基因型慢性乙型肝炎的疗效

目前依据S区基因的序列异质性≥4%,将HBV分为A～H 8种基因型[1-2],基因型反映了HBV自然感染发生变异特点,是病毒变异进化的结果.越来越多的证据表明,HBV基因型可能与病毒感染途径,基因突变,疾病的进程,抗病毒疗效具有一定相关性[3-5],尤其HBV C基因型的患者,对单用IFN疗效较差.本研究自2006年4月-2008年11月选择HBV C基因型、HBeAg阳性的慢性乙型肝炎患者采用拉米夫定(LAM)+干扰素(IFN)、阿德福韦(ADV)+ IFN、胸腺肽α1(Tα1)+IFN治疗,并与单用IFN相对照.     

乙肝病毒相关性肝癌中癌基因和抑癌基因的研究进展

近年来在乙型肝炎病毒(HBV)相关性肝癌中癌基基因ras.mye.for和抑癌基因p53、RB、TTR、nm23及p16等研究中发现，癌基因的突变和HBV基因产物的转化激活使其过量表达：抑癌基因的突变失活,与HBV蛋白产物的结合，以及抑癌基因产物表达、磷酸化过程的异常均与肝癌的发生发展和分化、转移有关。     

干扰素α-8与乙型肝炎病毒-S2S融合基因真核表达质粒在哺乳动物细胞中的表达

目的构建干扰素α-8(IFNα-8)与乙型肝炎(HB)病毒(HBV)-S2S融合蛋白的真核表达质粒pVAX1/IFNα-8-S2S,作为一种高效能HB DNA疫苗的备选对象.方法以特定引物分别从正常胎肝组织及HB患者血清中扩增出IFNα-8与HBV-S2S基因片段,克隆至相应载体.再以连接引物扩增出IFNα-8与HBV-S2S融合基因片段,并将该基因片段克隆至真核细胞表达载体pVAX1,然后扩增目的基因测序,确认无误后,转染SP2/0细胞,并分别检测目的基因mRNA,了解其短暂表达与稳定表达情况.结果所构建的质粒经过酶切电泳后证实分子量与预期相符,目的片断IFNα-8-S2S经测序证实IFNα-8序列与Genebank公布的序列相符.HBV-S2S存在3处三联密码子的无义突变.2处有义突变是703-705位CCG突变为CAG,799～801位ATA突变为ATG.表达质粒转染SP2/0细胞后,均检测到短暂表达及稳定表达之目的基因mRNA.结论经分析表明,HBV-S2S片段存在的两处有义突变并不影响该蛋白的空间构象及关键抗原决定簇的性质.可以认为本研究完成了真核表达质粒pVAX1/IFNα-8-S2S的构建,并成功检测到目的基因的表达,为制造高效能HB DNA疫苗提供了新的备选对象.     

拉米夫定治疗前后乙型肝炎病毒YMDD变异的相关因素分析

目的 了解遵义地区HBV基因型以及拉米夫定治疗前后发生YMDD变异的相关因素,及早进行拉米夫定疗效及耐药的预测. 方法 53例慢性乙型肝炎患者分别在口服拉米夫定前及治疗后3、6、12、18、24个月进行血清HBV DNA定量、乙型肝炎标志物、ALT、AST、总胆红素,白蛋白的检测.同时在接受拉米夫定治疗前采用基因测序法检测HBV基因型及YMDD变异株,治疗后HBV DNA定量下降又反弹升高,且血清HBV DNA＞1×104拷贝/ml时,再次进行YMDD变异株检测.率的比较用卡方检验及确切概率法,两组均数之间比较采用独立样本t检验,有序变量之间的比较采用秩和检验.结果 遵义地区的HBV基因型由B、C及B+C基因型构成.拉米夫定治疗后18例检出YMDD变异株,用药1年和2年的变异率分别为15.1%和34.0%.HBV突变类型有rtL180M/M204V、rtL180M/M204I、rtM204I和rtL180M四种,其中C区rtM204V全部合并rtL180M突变(100%),C基因型中rtL180M/M204V联合突变及rtL180M/M204I联合突变明显高于B基因型(77.8%比25.0%及22.2%比12.5%);C基因型中未见点突变,而rtM204I、rtL180M的点突变仅见于B基因型.YMDD变异与未变异组性别、民族、乙型肝炎家族史及HBeAg情况差异无统计学意义(P＞0.05),病程≥2年组和年龄＜35岁组变异率明显升高(X2值分别为4.707和5.853,P值均＜0.05).不同HBV DNA滴度患者YMDD变异率差异无统计学意义(X2=0.801,P＞0.05),但HBV DNA＜105拷贝/ml者未发现YMDD变异.结论 拉米夫定治疗后YMDD变异可能与HBV基因型及P基因突变类型有关,并随治疗时间的延长而增加.为了减少YMDD变异的发生,应选用病程短、HBV DNA水平较低、肝损害较重的患者进行拉米夫定治疗,有条件的应检测HBV基因型.     

干扰素α-8与乙型肝炎病毒-S2S融合基因真核表达质粒在哺乳动物细胞中的表达

目的：构建干扰素α-8(IFNα-8)与乙型肝炎(HB)病毒(HBV)-S2S融合蛋白的真核表达质粒pVAXl／IFNα-8-S2S，作为一种高效能HBDNA疫苗的备选对象。方法：以特定引物分别从正常胎肝组织及HB患者血清中扩增出IFNα-8与HBV—S2S基因片段，克隆至相应载体。再以连接引物扩增出IFNα-8与HBV-S2S融合基因片段，并将该基因片段克隆至真核细胞表达载体pVAXl，然后扩增目的基因测序，确认无误后，转染SP2／0细胞，并分别检测目的基因mRNA，了解其短暂表达与稳定表达情况。结果：所构建的质粒经过酶切电泳后证实分子量与预期相符，目的片断IFNα-8-S1S经测序证实IFNα-8序列与Genebank公布的序列相符。HBV-S2S存在3处三联密码子的无义突变。2处有义突变是703～705位CCG突变为CAG，799～801位ATA突变为ATG。表达质粒转染SP2／0细胞后，均检测到短暂表达及稳定表达之目的基因mRNA。结论；经分析表明，HBV-S2S片段存在的两处有义突变并不影响该蛋白的空间构象及关键抗原决定簇的性质。可以认为本研究完成了真核表达质粒pVAXl／IFNα-8-S2S的构建，并成功检测到目的基因的表达，为制造高效能HBDNA疫苗提供了新的备选对象。     

白细胞介素28B基因多态性与慢性HBV、HCV感染的相关性

HBV、HCV感染具有慢性化的流行特点。白细胞介素(IL)28B基因多态性与HBV、HCV感染慢性化及干扰素(IFN)抗病毒疗效具有相关性。简述了IL-28B生物学功能及特点,述评了IL-28B基因多态性与HCV感染的相关性,并归纳了目前发现的IL-28B基因多态性与HBV感染的相关性的众多研究报道。分析表明,IL-28B基因多态性与丙型肝炎病程转归及IFN抗病毒疗效的相关性研究报道较为一致;而IL-28B基因多态性与乙型肝炎病程转归,HBV感染后肝硬化、肝癌及IFN抗病毒疗效的相关性研究,各方学者均有不同的见解,尚需进一步的研究。     

乙型肝炎病毒载量及ALT水平与干扰素应答关系的研究

探讨慢性乙型肝炎患者血清病毒载量及ALT水平在预测IFN疗效中作用.50例慢乙肝患者接受重组IFN治疗24周并随访一年以上.IFN治疗后20例患者(40%)持续应答,应答组治疗前HBV DNA水平显著低于无应答组(P＜0.05).50例IFN治疗患者中26例(52%)为高病毒血症水平(HBV DNA＞107Copies/ml),24例(48%)为低病毒血症水平(HBV DNA＜107 Copies/ml),低病毒血症水平组血清HBV DNA及HBeAg阴转率显著高于高病毒血症水平组(54%vs 25%和46.1%vs16.7%,P均＜0.05).多变量分析显示,治疗前高水平ALT、低HBVDNA含量及治疗过程中ALT明显升高(＞4倍以上)是判断干扰素治疗的患者HBV DNA阴转的独立预测因素(P＜0.05).乙型肝炎病毒载量及治疗前和治疗过程中ALT升高与IFN应答密切相关.     

乙肝病毒相关性肝癌中癌基因和抑癌基因的研究进展

近年来在乙型肝炎病毒(HBV)相关性肝癌中癌基因 ras、myc、fos 和抑癌基因 p53、RB、TTR、nm23及 p16等研究中发现,癌基因的突变和 HBV 基因产物的转化激活使其过量表达;抑癌基因的突变失活,与 HBV 蛋白产物的结合,以及抑癌基因产物表达、磷酸化过程的异常均与肝癌的发生发展和分化、转移有关。     

核苷(酸)类似物序贯干扰素治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎患者的临床观察

目的 观察HBeAg阳性慢性乙型肝炎(CHB)患者在核苷(酸)类似物抗病毒治疗基础上序贯聚乙二醇干扰素α-2a(PEG IFNα-2a)治疗48周血清HBsAg的变化.方法 6例HBeAg阳性CHB患者中,3例采用核苷(酸)类似物序贯PEG IFNα-2a治疗48周,3例维持原核苷(酸)类似物治疗方案,每12周采用实时PCR定量检测HBV DNA,采用时间分辨免疫荧光分析法检测HBsAg、抗-HBs、HBeAg、抗-HBe及抗-HBc.结果 核苷(酸)类似物序贯PEG lFNα-2a治疗48周后,3例序贯治疗患者血清HBsAg均消失,而维持原核苷(酸)类似物治疗患者血清HBsAg效价为100～320 IU/mL.结论 对核苷(酸)类似物治疗产生较好应答反应且伴有血清HBsAg效价明显下降的HBeAg阳性CHB患者,在核苷(酸)类似物抗病毒治疗基础上序贯PEG IFNα-2a治疗48周能有效促进血清HBsAg下降,并出现血清HBsAg消失的现象.     

干扰素α与阿德福韦酯不同联合方法治疗HBeAg阳性慢性乙型肝炎的疗效

目的 观察IFNα联合阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)的临床疗效,探讨理想的联合治疗方案.方法 2005年1月至2009年6月纳入河北医科大学第三医院HBeAg阳性CHB患者156例.56例患者HBV DNA≥1×107拷贝/mL、或纤维化分期≥S3、或既往单药治疗失败(复发)者,予以初始IFNα联合ADV治疗;52例未达上述指标患者接受初始IFNα单药治疗.24周时依据患者HBV DNA、HBeAg、HBsAg变化调整治疗方案:16例取得早期应答的初始IFNα联合ADV治疗组患者调整为IFNα单药维持治疗,其余患者与初始IFNα单药治疗组未达到早期应答者共同接受IFNα联合ADV治疗.另选48例作为标准治疗组,接受全程IFNα单药治疗.48周时复评全部患者HBV DNA、HBeAg、HBsAg定量,并决定是否延长疗程.最终于72周评估患者疗效、安全性、耐药复发等,数据行卡方检验.结果 治疗24周,初始IFNα联合ADV治疗组早期应答率达28.6%,其中HBV DNA阴转率、ALT复常率(53.6%,62.5%)与初始IFNα单药治疗组(32.7%,x2=4.78;40.4%,x2=5.21)、标准治疗组(27.1%,x2=5.28;37.5%,x2=6.46)比较,差异均有统计学意义(均P<0.05),且HBeAg阴转率较标准治疗组更高(39.3%比18.8%,x2=7.48,P<0.05).48周时,初始IFNα联合ADV治疗组16例取得早期应答者停用ADV后,5例HBeAg复阳,3例病毒学反弹;HBV DNA阴转率为73.2%,HBeAg转换率为41.1%,HBsAg清除率为12.5%.其中96例接受不同联合方法治疗的患者HBV DNA阴转率、HBeAg转换率、HBsAg清除率分别为65.6%、33.3%和8.3%.72周时不同联合方法治疗组患者整体复发率与标准治疗组相当,HBsAg清除率上升2.7%.结论 IFNa联合ADV抗病毒治疗对提高应答率优势明显.结合患者基线特征、治疗反应,制订不同联合方案,不失为当前CHB抗病毒优化治疗理想策略之一.

Abstract：

Objective To investigate the efficacy of interferon α(IFNα)and adefovir dipivoxil (ADV)combination therapy in HBeAg positive chronic hepatitis B(CHB)patients and to explore the optimized strategy for individualized treatment.Methods A total of 156 HBeAg positive CHB patients were enrolled in the study from January 2005 to June 2009 in the Third Affiliated Hospital of Hebei Medical University.Fifty-six CHB patients with hepatitis B virus(HBV)DNA≥1 X 107copy/mLand/or liver fibrosis stage≥S3,or previous monotherapy failure(relapse)were treated with initial IFNα and ADV combination therapy.Fifty-two patients who didn't meet any of the above baseline characteristics received initial IFNα monotherapy.The remaining 48 patients treated with IFNα monotherapy for full treatment duration were considered as control.At week 24 of treatment,the treatment regimens were adjusted according to quantitative changes of HBV DNA,HBeAg and HBsAg:16 patients who achieved early response in group of initial IFNα and ADV combination therapy subsequently received IFNα monotherapy,the other patients in group of initial combination therapy together with patients who did not achieved early response in group of initial IFNα monotherapy subsequently received IFNα and ADV combination treatment.The HBV DNA levels,HBeAg and HBsAg titers were detected at the end of 48 weeks of treatment to determine the treatment duration.The treatment efficacy,safety,drug resistance and relapse rates were finally evaluated at week 72.All data were analyzed using chi square test.Results At week 24,the early response rate in group of initial combination therapy was 28.6%,and the HBV DNA negative rate and alanine aminotransferase(ALT)normalization rate were significantly higher than those in groups of initial IFNα monotherapy and control(53.6%vs 32.7%vs 27.1%and 62.5%vs 40.4%vs 37.5%,respectively,P<0.05);in addition,HBeAg loss rate was higher than control group(39.3%vs 18.8%,x2=7.48;P<0.05).At week 48,five of 16 patients who achieved early response developed HBeAg reversion and three cases accompanied with virological breakthrough in group of initial combination therapy after switching to IFNα monotherapy,while the rates of HBV DNA negative,HBeAg seroconversion and HBsAg clearance were 73.2%,41.1%and 12.5%,respectively.The HBV DNA negative rate,HBeAg seroconversion rate and HBsAg clearance rate in 96 patients Who had received different combination treatment regimens were 65.6%,33.3%and 8.3%,respectively.At week 72,the relapse rate in individualized treatment group was comparable to those in control group,while HBsAg clearance rate increased 2.7%in individualized treatment group.Conclusions IFNα and ADV combination treatment could improve early biochemical and virological responses.Individualized treatment strategy based on baseline characteristics and treatment responses may be helpful for optimizing antiviral treatment in CHB patients.     

干扰素抗体对干扰素α-1b疗效影响的动态研究

采用酶联免疫法检测了１４８例接受干扰素（ＩＦＮ）治疗慢性乙肝患者血清中的干扰素体（抗－ＩＦＮ），结合ＨＢＶ ＤＮＡ荧光定量检测动态分析抗－ＩＦＮ产生对ＩＦＮ疗效的影响。结果显示：在抗体阳性者中，抗－ＩＦＮ的产生能够逆转ＨＢＶ ＤＮＡ水平的下降趋势，应答率和持续应答率均明显低于抗体阴性者（Ｐ〈０．０１）。提示抗－ＩＦＮ可能是影响ＩＦＮ近、远期疗效的重要因素。     

Efficacy of 6-month interferon therapy in chronic hepatitis B virus infection in Japan

Background In Japan, there are few studies of long-term (more than 1 month) interferon (IFN) therapy for chronic hepatitis B (CHB). In this retrospective study, we investigated the efficacy and predictors of response to 6-month IFN therapy.Methods We analyzed 66 Japanese patients with CHB who were treated with IFN for 6 months. They comprised patients who were hepatitis B e antigen (HBeAg)-positive (n = 45) and -negative (n = 21). One (2%), 8 (12%), and 51 (77%) patients were infected with hepatitis B virus (HBV) genotypes A, B, and C, respectively. Responders in patients positive for HBeAg were defined as those who showed normalization of serum alanine aminotransferase (ALT) level, HBeAg loss, and HBV DNA negativity at 6 months after completion of IFN therapy. In patients negative for HBeAg, responders were defined as those patients who showed normalization of ALT level and HBV DNA negativity at the same 6-month time point.Results Of the 45 patients with HBeAg at the commencement of IFN therapy, 9 (20%) were responders. Young patients, especially those with a high serum ALT level, were significantly more likely to respond to IFN therapy. Of the 21 patients negative for HBeAg, 13 (62%) were responders. There were no significant differences in clinical characteristics between responders and nonresponders among patients negative for HBeAg. Multivariate analyses identified HBeAg negativity and young age as independent factors associated with a positive response to 6-month IFN therapy. However, long-term follow-up of the treated patients showed a fall in the response rate.Conclusions The response rate to 6-month IFN therapy among HBeAg-positive patients was low. However, young patients may require long-term IFN therapy.     

Effects of pegylated interferon‐α based therapies on functional cure and the risk of hepatocellular carcinoma development in patients with chronic hepatitis B

Chronic hepatitis B virus (HBV) infection continues to pose a serious global health threat and a significant socio‐economic burden in many areas of the world. Almost all current clinical practice guidelines on the management of chronic hepatitis B (CHB) infection recommend that eligible patients pursue the optimal treatment endpoint, which is defined as HBsAg loss with or without anti‐HBs seroconversion. This review describes the effects of various regimens containing pegylated interferon (peg‐IFN)‐alpha on functional cure and the outcome of hepatocellular carcinoma (HCC) in patients with CHB. Peg‐IFN‐α monotherapy is a treatment option recommended by local and international clinical practice guidelines to help more CHB patients achieve a sustained off‐treatment virological response, which is particularly appropriate for relatively young patients who demand a finite treatment approach. Peg‐IFN‐α add‐on or sequential therapy in patients who have achieved a suppressed viral load after nucleos(t)ide analog (NA) therapy may offer further benefits on HBeAg seroconversion and HBsAg decline, although the effects of de novo combination therapy with peg‐IFN‐α and NAs on long‐term outcomes remain unclear. Evaluation of baseline and on‐treatment predictors is useful for selecting the patients who are likely to achieve additional benefits. Furthermore, some recent studies have shown that peg‐IFN‐α–based therapy results in better prevention of HBV‐related hepatocellular carcinoma (HCC), especially in high‐risk patients.     

Interferon‐α treatment in children and young adults with chronic hepatitis B: a long‐term follow‐up study in Taiwan

Background/Aims: The short‐ and long‐term benefits of interferon (IFN)‐α therapy in young patients with chronic hepatitis B (CHB) acquiring infection perinatally or during early childhood have been questioned. Methods: Twenty‐one Taiwanese hepatitis B envelope antigen (HBeAg)‐positive CHB patients aged 1.8–21.8 years (median 14.0 years) with alanine aminotransferase (ALT)>80 IU/L at entry were enrolled for IFN‐α therapy. They received IFN‐α therapy with a dose of 3 MU/m²/day three times a week for 24 weeks. A control group included untreated 21 CHB patients closely matched for gender, age, duration of ALT >80 IU/L and HBeAg status. All 42 patients were prospectively followed for 6.5–12.5 years after the end of therapy. Results: The cumulative rate of virological response [anti‐HBe seroconversion and serum hepatitis B virus (HBV)‐DNA <10⁵ copies/ml] was not different between the IFN‐treated patients and control patients at 1 year (41 vs 44%) and at 6 years (88 vs 89%) after stopping treatment. Serum hepatitis B surface antigen loss occurred in two (9.5%) treated patients and in one (4.8%) control patient. Patients with a successful treatment response (anti‐HBe seroconversion, HBV‐DNA <10² copies/ml and ALT normalization at 1 year after stopping treatment) were younger than those without a successful response (P=0.03). A lower pretreatment serum HBV‐DNA level (<2 × 10⁸ copies/ml) is not only a significant factor to predict successful treatment response (P=0.008) but also has a beneficial effect on the long‐term cumulative rate of virological response in IFN‐treated patients (P=0.021), but not in control patients. Genotype difference or emergence of a precore stop codon mutant before treatment was not predictive for HBeAg clearance. Conclusion: For young CHB patients in Taiwan with infection occurring perinatally or in early childhood, the real advantage of IFN‐α therapy was not observed. IFN‐α therapy showed a beneficial effect on short‐ and long‐term virological outcomes only in those with a lower pretreatment serum HBV‐DNA level.     

Effect of nucleoside analog‐interferon sequential therapy on patients with acute exacerbation of chronic hepatitis B

Aim: Nucleoside analog (NA)‐interferon (IFN) sequential therapy may enable the long‐term control of chronic hepatitis B (CHB) and the withdrawal of the nucleoside analog. We evaluated the efficacy of NA‐IFN sequential therapy for acute exacerbation of CHB. Methods: A total of 12 patients with acute exacerbation of CHB, nine of whom were positive for hepatitis B e antigen (HBeAg), were enrolled in this study. All the patients were treated with lamivudine 100 mg/day alone for 20 weeks, then with both IFN‐α 6 megaunits three times per week and lamivudine for 4 weeks, and lastly, with IFN‐α alone for 20 weeks. Patients whose serum alanine aminotransferase (ALT) level was normalized, whose serum hepatitis B virus (HBV) DNA level decreased to less than 5 log copies/mL, and HBeAg level was absent 24 weeks after the end of treatment were defined as having sustained virological response (SVR). The other patients were defined as having no response (NR). Results: Four out of nine (44.4%) HBeAg‐positive and all three HBeAg‐negative patients achieved SVR. The levels of serum alanine aminotransferase (ALT), HBV DNA and HBV core‐related antigen were similar between SVR and NR patients at baseline. Three of four patients (75.0%) whose serum HBeAg became negative at the end of treatment achieved SVR, while one of five (20.0%) whose serum HBeAg remained positive achieved SVR. Conclusion: NA‐IFN sequential therapy for patients with acute exacerbation of CHB enables the withdrawal of treatment and is particularly effective for patients whose serum HBeAg has become undetectable by the end of the IFN treatment.     

Long-term efficacy of interferon therapy in patients with chronic hepatitis B virus infection in Japan

Background

Few studies have investigated the long-term effects of interferon (IFN) therapy for chronic hepatitis B (CHB). In this retrospective study, we investigated the efficacy of and predictors of response to IFN therapy in CHB patients.

Methods

We analyzed data for 615 Japanese CHB patients (hepatitis B e antigen [HBeAg]-positive 414, HBeAg-negative 201) treated with IFN, and conducted follow up for a median duration of 8.1 years (range 0.5–23.2). Responders were defined as patients who showed continuously normalized alanine transaminase (ALT) levels, HBeAg clearance, and low hepatitis B virus (HBV) DNA levels at 6?months post-treatment or for a span of more than 6?months until each test point at 1, 3, 5, and 10?years.

Results

The IFN response rates of all patients were 21, 18, 21, 23, and 25% at 6?months and 1, 3, 5, and 10?years, respectively. On multivariate analysis, significant determinants of the outcome of IFN therapy were as follows: at 6?months and 1?year, young age, low HBV DNA levels, and long duration of treatment; at 3?years, long duration of treatment, young age, and high level of albumin; at 5?years, high level of albumin, female, and pretreated with IFN; and at 10?years, HBeAg-negative. Sixty-nine of the 615 patients (11%) achieved seroclearance of hepatitis B surface antigen (HBsAg). On multivariate analysis, age ≥30?years, HBV genotype A, and male were all independent factors predicting the achievement of HBsAg seroclearance.

Conclusion

HBeAg, HBV DNA level, age, sex, albumin, duration of treatment, pretreatment with IFN, and HBV genotype were important factors in determining long-term response to IFN therapy.     

Characterization of microRNA expression profiles associated with hepatitis B virus replication and clearance in vivo and in vitro

Background and Aim: Alpha interferon (IFN‐α) is an approved treatment for chronic hepatitis B (CHB). MicroRNA (miRNA) are currently known as a part of IFN‐mediated antiviral defense. We aimed at characterizing the miRNA expression associated with hepatitis B virus (HBV) replication and IFN‐mediated HBV clearance. Methods: We investigated the expression patterns of cellular miRNA induced by HBV replication and/or IFN‐α treatment in HepG2 cells, and also analyzed the miRNA response in peripheral blood mononuclear cells in CHB patients on IFN‐α treatment. The differentially expressed miRNA were verified using quantitative real‐time polymerase chain reaction and an miRNA expression pattern was classified based on the final virological response. Results: A total of 223 miRNA were differentially expressed (> 1.5 folds) between the HepG2.2.15 and HepG2 cells, including 24 highly differentially expressed miRNA (> 5 folds). With 12 h of IFN‐α treatment, 23 totally differentially expressed miRNA were identified in HepG2 cells; whereas only five miRNA were identified in HepG2.2.15 cells. Similar amounts of the miRNA were regulated in patients with HBeAg or non‐HBeAg seroconversion; whereas levels of eight miRNA were significantly differentially expressed between the two groups. Conclusions: HBV replication alters miRNA expression profiles and impairs IFN‐inducible miRNA response in HepG2 cells. The miRNA expression pattern of peripheral blood mononuclear cells in CHB patients with IFN therapy can be associated with their therapeutic outcome.     

Pegylated interferon alfa for chronic hepatitis B: systematic review and meta‐analysis

Conventional interferon alfa and nucleos(t)ide analogues, such as lamivudine, are frequently used for chronic hepatitis B (CHB) treatment, but are associated with adverse effects and viral resistance. Here we performed a systematic review and meta‐analysis evaluating all studies of pegylated interferon alfa (PEG‐IFNα) treatment in hepatitis B e antigen (HBeAg)‐positive and HBeAg‐negative patients with CHB. We searched electronic databases – PubMed, EMBASE, Cochrane Library and LILACS – for randomized controlled trials evaluating PEG‐IFNα therapy between 1999 and September 2014. Virological response was the primary outcome. We identified 14 studies involving 2829 patients. Our analysis revealed that PEG‐IFNα + lamivudine combination therapy produced better virological and biochemical responses than PEG‐IFNα monotherapy in HBeAg‐positive and HBeAg‐negative patients at the end of treatment. PEG‐IFNα + adefovir dipivoxil achieved better seroconversion rate than PEG‐IFNα in HBeAg‐positive patients at the end of treatment. The present findings demonstrated a beneficial response rate following PEG‐IFNα combination therapy with nucelos(t)ides among HBeAg‐positive and HBeAg‐negative patients with CHB. Further trials are needed to investigate simultaneous and sequential therapy strategies.