In vivo immunization following virus suppression: a novel approach for inducing immune control in chronic hepatitis B.
summary. Antiviral treatment of patients with active chronic hepatitis B may lead to significant reduction in morbidity and mortality. However, after stopping nucleoside therapy, relapse rates are high in those without acquired specific immunity. We have treated two chronic hepatitis B patients with in vivo immunization. In vivo immunization aims to optimize conditions for an effective immune response: following rapid and profound virus suppression by interferon-lamivudine combination therapy, lamivudine is withdrawn intermittently for 4 weeks during continued interferon therapy. In both patients with profound virus suppression a rapid rebound in viral replication was observed after lamivudine withdrawal; despite continued interferon. These periods of renewed viral replication were followed by rises in hepatitis activity. After re-introduction of lamivudine HBV DNA became undetectable by PCR followed by normalization of serum ALT. These observations are a stimulus to further explore the concept of in vivo immunization as a novel therapeutic approach for chronic hepatitis B.
Sprengers
D
D
Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Janssen
H L A
HL
Kwekkeboom
J
J
Niesters
H G M
HG
de Man
R A
RA
Schalm
S W
SW
D000328:Adult; D000410:Alanine Transaminase; D000998:Antiviral Agents / Q000494:pharmacology*; D002908:Chronic Disease; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000276:immunology* / Q000628:therapy / Q000821:virology; D006801:Humans; D007114:Immunization; D016898:Interferon-alpha / Q000627:therapeutic use*; D019259:Lamivudine / Q000494:pharmacology*; D014779:Virus Replication / Q000187:drug effects*
D000998:Antiviral Agents; D004279:DNA, Viral; D016898:Interferon-alpha; D019259:Lamivudine; D000410:Alanine Transaminase