The influence of baseline characteristics on viral dynamic parameters in chronic hepatitis B patients treated with lamivudine.
OBJECTIVE
Viral decline during lamivudine therapy in chronic hepatitis B patients is bi-phasic. We studied the influence of lamivudine dose and baseline characteristics on parameters obtained from a mathematical model.


METHODS
Chronic hepatitis B patients were randomized to receive 150 mg (group 1; n=11) or 600 mg (group 2; n=10) lamivudine daily for 4 weeks. Hepatitis B virus DNA was measured frequently with the Digene Hybrid Capture II test and the Roche PCR assay.


RESULTS
The description of viral decline in our closely monitored patients by means of the mixed-effects approach with both the bi-phasic model and a piecewise linear regression model resulted in a good fit. Baseline alanine aminotransferase (ALT) was significantly related to the slope of the second phase of viral decline. Previous lamivudine-treated patients showed a significant slower first phase than patients naive to lamivudine treatment.


CONCLUSIONS
The initial observed difference in viral decline between 150 and 600 mg of lamivudine disappeared when baseline ALT was taken into account. This strengthens the hypothesis that the level of intrinsic activity is related to the turnover of infected hepatocytes. Moreover, reintroduction of lamivudine in previously lamivudine-treated patients should be considered carefully.
Department of Hepatogastroenterology, University Hospital Rotterdam, The Netherlands.
Leonieke M M
LM
Wolters
Bettina E
BE
Hansen
Hubert G M
HG
Niesters
Rachel S
RS
Levi-Drummer
Avidan U
AU
Neumann
Solko W
SW
Schalm
Robert A
RA
de Man
D000293:Adolescent; D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine