Early virological response predicts outcome during extended lamivudine retreatment in patients with chronic hepatitis B who relapsed after initial HBeAg responses.
OBJECTIVE
Studies from hepatitis B virus endemic areas have shown less durable lamivudine-induced responses and have raised issues about the management of a post-treatment relapse.


METHODS
From January 2000 to June 2004, all 51 patients (43 HBeAg-positive and eight HBeAg-negative) were retreated with lamivudine for at least 12 months. All had a post-treatment relapse after HBeAg responses (HBeAg loss/seroconversion) during the first therapy.


RESULTS
During retreatment, HBeAg seroconversion occurred more frequently in those patients with HBeAg seroconversion than in those with HBeAg loss alone during prior lamivudine therapy (P = 0.001). On multivariate analysis, prior HBeAg seroconversion and early virological response (EVR) (< or = 2 months of retreatment) independently predicted HBeAg seroconversion (P = 0.012 and P = 0.004, respectively). With regard to virological breakthrough, only the time to virological response (> 2 months of retreatment) remained significant (P = 0.048). Among the HBeAg-negative patients, virological breakthrough occurred in only one patient with a late virological response.


CONCLUSIONS
EVR is a major predictor in determining a favorable response to lamivudine retreatment. Our observations suggest that lamivudine retreatment will provide more therapeutic gains in those patients with a prior HBeAg seroconversion than in those with HBeAg loss alone.
Jang
Jeong Won
JW
Department of Internal Medicine and WHO Collaborating Center on Viral Hepatitis, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Bae
Si Hyun
SH
Choi
Jong Young
JY
Kim
Chang Wook
CW
Han
Nam Ik
NI
Han
Jun Yeol
JY
Choi
Sang Wook
SW
Yoon
Seung Kew
SK
Chung
Kyu Won
KW
Sun
Hee Sik
HS
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012150:Polymorphism, Restriction Fragment Length; D019233:Retreatment; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine