title: Lamivudine treatment in HBeAg-negative chronic hepatitis B patients with low level viraemia.
abstract: BACKGROUND
  Our aim was to determine the short-term natural course of viraemia and the response to lamivudine treatment in HBeAg-negative chronic hepatitis B patients with a persistently low hepatitis B virus (HBV)-DNA level.
  
  
  METHODS
  A total of 55 patients were included. Group 1 consisted of 37 patients with low-level viraemia and high serum alanine aminotransferase (ALT) levels and further randomized to two groups: group 1a (n=19) patients received 1 year of lamivudine therapy and group 1b (n=18) patients were untreated controls. Group 2 consisted of 18 inactive carriers who were followed as controls of untreated low viraemic chronic hepatitis B patients. HBV DNA was longitudinally determined by real-time polymerase chain reaction assay.
  
  
  RESULTS
  A female predominance in group 2 was observed while males were predominant in group 1. Mean age and baseline HBV-DNA levels did not differ between group 1 and 2 patients while group 1 patients had a higher histological score (P<0.01). Of group 1a patients, 44% had complete ALT normalization at end of treatment, whereas 21% untreated group 1b patients had normal ALT at the end of the follow-up. No change in histological activity was observed in group 1a patients at the end of treatment. HBV-DNA levels did not significantly change from baseline to end-of-treatment/observation period in patient groups. The viraemia course was not different across the groups.
  
  
  CONCLUSIONS
  Low viraemic HBeAg-negative patients with high ALT present with minimal/mild histological activity. Inactive carriers cannot be differentiated from low viraemic patients with high ALT based on HBV DNA determination. Although lamivudine treatment can be effective in some cases, observation rather than a prompt treatment attempt seems to be more logical because of mild histological changes and low response rate to treatment in these patients.
authors.affiliation: Department of Gastroenterology, Ankara University School of Medicine, Cebeci, Ankara-Turkey. bozkaya@medicine.ankara.edu.tr
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozkaya
authors.forename: Cihan
authors.initials: C
authors.lastname: Yurdaydin
authors.forename: Ramazan
authors.initials: R
authors.lastname: Idilman
authors.forename: Ali
authors.initials: A
authors.lastname: Tüzün
authors.forename: Kubilay
authors.initials: K
authors.lastname: Cinar
authors.forename: Ozlem
authors.initials: O
authors.lastname: Erkan
authors.forename: A Mithat
authors.initials: AM
authors.lastname: Bozdayi
authors.forename: Esra
authors.initials: E
authors.lastname: Erden
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Uzun
authors.forename: Hülya
authors.initials: H
authors.lastname: Cetinkaya
authors.forename: Ozden
authors.initials: O
authors.lastname: Uzunalimoglu
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D016133:Polymerase Chain Reaction; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014766:Viremia
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000410:Alanine Transaminase