Sheila Lumley, Maeve Barlow, Khadija Said, Emily Martyn, Elizabeth Waddilove, Marion Delphin, Daisy Jennings, Haiting Chai, Agnes Kemper, Joy Ko, Azim Ansari, Douglas Macdonald, Indrajit Ghosh, Samreen Ijaz, Stuart Flanagan, Philippa Clare Matthews
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引用次数: 0
摘要
诊断和治疗慢性乙型肝炎病毒(HBV)感染是支持到 2030 年消除病毒性肝炎的关键干预措施。尽管核苷/肽类似物(NA)疗法通常非常有效,但病毒载量(VL)抑制仍面临挑战,包括药物获取、不完全依从性和耐药性。我们介绍了一个病例,该病例是一名长期接受连续 NA 疗法治疗的 HBV 和 HIV 合并感染成人,曾出现过突破性病毒血症。导致病毒血症突破的因素有多种,包括接触旧的 NA 药物、最初的高 HBV VL、治疗中断、并发症以及耐药性突变的潜在影响。该病例强调了个体化治疗方法和坚持治疗对实现 HBV 抑制的重要性。此外,该病例还强调了改进临床路径的必要性,以解决教育、支持和获得护理的问题,尤其是对边缘化人群而言。全面收集包括代表性不足人群在内的数据对于保持治疗效果和提供有效干预措施至关重要。
Multiple risk factors for persistent HBV viraemia in an adult receiving nucleos/tide analogue therapy.
Diagnosing and treating chronic hepatitis B virus (HBV) infection are key interventions to support progress towards elimination of viral hepatitis by 2030. Although nucleos/tide analogue (NA) therapy is typically highly effective, challenges remain for viral load (VL) suppression, including medication access, incomplete adherence and drug resistance. We present a case of a long-term HBV and HIV coinfected adult prescribed with sequential NA therapy regimens, with episodes of breakthrough viraemia. Multiple factors contribute to virological breakthrough, including exposure to old NA agents, initial high HBV VL, therapy interruptions, intercurrent illnesses and potential contribution from resistance mutations. The case underscores the importance of individualised treatment approaches and adherence support in achieving HBV suppression. Furthermore, it emphasises the need for improved clinical pathways addressing education, support and access to care, particularly for marginalised populations. Comprehensive data collection inclusive of under-represented individuals is crucial for maintaining retention in the care cascade and informing effective interventions.
期刊介绍:
Sexually Transmitted Infections is the world’s longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI provides a high quality editorial service from submission to publication.