Factors related to post-treatment relapse in chronic hepatitis B patients who lost HBeAg after lamivudine therapy.
OBJECTIVE
It is uncertain if a patient's lamivudine response after HBeAg loss is durable. In Korean chronic hepatitis B patients, the relapse rate is high after termination of lamivudine therapy for patients with HBeAg loss. We evaluated the factors related to relapse in chronic hepatitis B patients with HBeAg loss after lamivudine therapy.


METHODS
A total of 132 chronic hepatitis B patients, who initially had HBeAg and did not have decompensated features, were analyzed in this study. These patients lost the HBeAg after lamivudine therapy and then their therapy was stopped. Post-treatment serum alanine aminotransferase (ALT), HBeAg, anti-HBe and hepatitis B virus (HBV) DNA were monitored until relapse.


RESULTS
Seventy-five patients relapsed (cumulative relapse rate: 56% at 6 months). Upon univariate analysis, the factors of age, serum total bilirubin, presence of anti-HBe after HBeAg loss, and the duration of additional lamivudine therapy after HBeAg loss were associated with relapse. Upon multivariate analysis, older age, a higher serum total bilirubin and the shorter duration of additional lamivudine therapy were significant risk factors for relapse. Patterns of relapse were the re-elevation of ALT, re-emergence of HBV DNA (69 patients) and reappearance of HBeAg (55 patients).


CONCLUSIONS
To prevent relapse in patients with chronic hepatitis B infection after lamivudine therapy, age and serum bilirubin level of patients as well as a prolonged duration of additional lamivudine therapy should be considered.
Byun
Kwan Soo
KS
Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea. kwsbyun@unitel.co.kr
Kwon
Oh Sang
OS
Kim
Ju Hyun
JH
Yim
Hyung Joon
HJ
Chang
Yun Jung
YJ
Kim
Jin Yong
JY
Yeon
Jong Eun
JE
Park
Jong Jae
JJ
Kim
Jae Seon
JS
Bak
Young Tae
YT
Lee
Chang Hong
CH
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007723:Korea / Q000453:epidemiology; D019259:Lamivudine / Q000008:administration & dosage*; D008111:Liver Function Tests; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D019233:Retreatment; D012307:Risk Factors
D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D019259:Lamivudine