Quantitativo DNA do VHB rastreia a resposta durante a terapêutica com nucleos(t)ídeo-analógico (NA) com ente...
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| ID | BMA-HBV-DNA-MONITORING-ANTIVIRAL-RESPONSE |
|---|---|
| Tipo | Relevância terapêutica |
| Estado | reviewed 2026-05-18 | actionability review required |
| Doenças | DIS-HCC |
| Fontes | SRC-AASLD-HBV-2024 SRC-AASLD-HCC-2023 SRC-EASL-HBV-2025 |
Fatos de ação
| Biomarcador | BIO-HBV-DNA-QUANTITATIVE-MONITORING |
|---|---|
| Variante | ADN do VHB quantitativo — monitorização da carga viral durante a terapêutica analógica com nucleos(t)ídeos |
| Doença | DIS-HCC |
| Nível ESCAT | IIIA |
| Combinações recomendadas | Continued antiviral on full suppression (entecavir, TAF, TDF), HCC surveillance regardless of DNA — see BMA-AFP-HCC-AASLD-SURVEILLANCE (US/AFP q6mo in cirrhotics and high-risk non-cirrhotics) |
| Contraindicated monotherapy | lamivudine monotherapy (high resistance — superseded), adefovir monotherapy (low potency — superseded) |
| Resumo das provas | Quantitative HBV DNA tracks response during nucleos(t)ide-analogue (NA) therapy with entecavir (ETV) or tenofovir alafenamide/disoproxil (TAF/TDF). Effective suppression (HBV DNA <2,000 IU/mL, ideally undetectable) is the primary virologic response endpoint per AASLD HBV 2024 and EASL HBV 2025. Sustained suppression reduces HCC incidence by ~50-70% in CHB cirrhotics (REVEAL-HBV cohort; Wong 2013 meta-analysis). Primary non-response or viral breakthrough (≥1-log rise on therapy) prompts adherence review, resistance testing, and regimen change (rare with ETV/TAF/TDF — high genetic barrier). ESCAT IIIA — biomarker directs antiviral continuation/switch decisions and is the primary HCC-prevention lever in chronic HBV. |
Notas
STUB pending two-Co-Lead signoff. HCC anchor reflects the primary oncology endpoint of HBV antiviral therapy — long-term suppression reduces but does not eliminate HCC risk; surveillance continues regardless of virologic suppression in cirrhotics (AASLD HCC 2023). HBeAg seroconversion is a parallel response endpoint not captured in this BMA (covered separately under BIO-HBV-STATUS). Engine must not treat detectable but stable low-level viraemia (<2,000 IU/mL) as treatment failure — AASLD specifically permits this state on continued NA therapy.
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