Retrospective analysis of the effect of nucleoside analogues on HBV reactivation due to glucocorticoid therapy

XIA Xu-hui; CHEN Xin

Abstract：Objective To retrospectively analyze the therapeutic efficacy of nucleoside analogues on HBV reactivation and activation of underlying immune diseases in chronically HBV-infected patients receiving glucocorticoid therapy due to underlying immune diseases. Methods A total of 131 HBV-infected patients receiving glucocorticoid therapy due to underlying immune diseases were enrolled in the study. They were divided into 3 groups according to the serum levels of HBV DNA and ALT. There were 41 patients in group A with normal serum level of ALT and HBV DNA ≤1×103 copies/ml, 67 patients in group B with ALT less than twice upper limits of normal (ULN) and HBV DNA >1 ×103 copies/ml but <1 ×104 copies/ml, and 23 patients in group C with ALT no less than twice ULN and HBV DNA ≥1 ×104 copies/ml. Antiviral treatment strategies included lamivudine (LAM) therapy, entecavir (ETV) therapy or LAM+adefovir dipivoxil (ADV) therapy. The serum levels of HBV DNA and ALT were detected every 3 months. Results Oral administration of nucleoside analogues could inhibit viral replication significantly, and helped control the activation of underlying immune diseases. If nucleoside analogue therapy was not given, the patients with HBV DNA>1 ×103 copies/ml would be at higher risk for viral replication and the activation of underlying immune diseases. However, regardless of the level of HBV DNA, the patients showed good response to LAM, ETV or LAM+ADV. Those who didn't respond well to LAM or LAM+ADV might obtain good response to ETV. Conclusions Patients receiving glucocorticoid therapy due to underlying immune diseases, regardless of the level of HBV DNA, should be given nucleoside analogue therapy, and early use of antiviral agents with high effectiveness and low drug resistance is recommended.