Analysis of clinical, biochemical and viral factors associated with early relapse after lamivudine treatment for hepatitis B e antigen-negative chronic hepatitis B patients in Taiwan.
The efficacy of lamivudine for HBeAg-negative chronic hepatitis B (CHB) Chinese patients has not been fully investigated. The role of the Hepatitis B virus (HBV) genotype on the treatment effect of lamivudine is controversial. Thirty-two consecutive patients with HBeAg-negative CHB were enrolled. All patients were treated with lamivudine 100 mg once daily of 7-12 months duration. The mean total period of follow-up since entry for all patients was 24 +/- 3.5 months. HBV genotypes were classified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and verified by sequencing. Precore (G1896A) and basic core promoter (BCP, A1762T & G1764A) mutations were determined by PCR and direct sequencing. Twenty-one (65.6%) patients were infected by genotype B and, 11 (34.4%) by genotype C. G1896A was predominant in genotype B infected patients (95.2%vs 63.6%, P = 0.037). At the end of treatment, 31 (96.8%) and 14 (43.8%) patients achieved biochemical and virological responses, respectively. The biochemical and virological response rates were 40.6 and 0% at 12 months after treatment. Eighteen (56.3%) patients had biochemical relapse within 12 months after withdrawal of lamivudine. By multivariate analysis, the pretreatment serum level of HBV DNA >/=12 Meq/mL was the only factor associated with early biochemical relapse (Odds ratio = 9.333, 95% CI = 1.497 approximately 58.197, P = 0.017). In conclusion, the virological effect of lamivudine for HBeAg-negative CHB is transient. Most patients had biochemical relapse within 12 months after lamivudine treatment regardless of HBV genotype. A high pretreatment viral load is the determinant for early biochemical relapse.
Huang
Y-H
YH
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Tainan, Taiwan, Republic of China.
Wu
J-C
JC
Chang
T-T
TT
Sheen
I-J
IJ
Lee
P-C
PC
Huo
T-I
TI
Su
C-W
CW
Wang
Y-J
YJ
Chang
F-Y
FY
Lee
S-D
SD
D000328:Adult; D000368:Aged; D001483:Base Sequence; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D015999:Multivariate Analysis; D016133:Polymerase Chain Reaction; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D018570:Risk Assessment; D012698:Serologic Tests; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013624:Taiwan; D016896:Treatment Outcome; D014758:Viral Core Proteins / Q000032:analysis / Q000235:genetics; D019562:Viral Load
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D014758:Viral Core Proteins; D019259:Lamivudine