title: Pre- and post-treatment predictors of the early achievement of HBeAg loss in lamivudine-resistant patients receiving adefovir therapy.
abstract: OBJECTIVE
  This study investigated the clinical variables that predict hepatitis B e antigen (HBeAg) loss in lamivudine-resistant patients receiving adefovir therapy.
  
  
  METHODS
  Fifty-six consecutive HBeAg-positive patients treated with adefovir for at least 12 months were enrolled in this study. All had serum alanine aminotransferase (ALT) levels over twice the upper limit of normal (ULN) as a result of lamivudine resistance. Predictors of HBeAg loss after switching from lamivudine to adefovir were examined.
  
  
  RESULTS
  During the follow-up period, 18 (32.1%) of 56 patients showed a loss of HBeAg. The estimated rates of HBeAg loss at 6, 12, and 18 months were 11.5%, 26.8%, and 42.9%, respectively. Univariate analysis revealed that pretreatment ALT levels >10 x ULN (P = 0.029), a viral load at 3 months of therapy (P = 0.017), and viral decline by >3 log(10) from baseline at 3 months (P < 0.001) were significantly associated with the loss of HBeAg within 12 months of therapy. With multivariate analysis using the stepwise logistic regression model, pretreatment ALT > 10 x ULN (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.09-19.44; P = 0.044) and viral suppression >3 log(10) at 3 months (OR, 10.39; 95% CI, 1.86-58.07; P = 0.008) were identified as the two independent predictors of HBeAg loss.
  
  
  CONCLUSIONS
  Pretreatment ALT levels and the initial pattern of post-treatment viral decline are the strongest predictors of the early achievement of HBeAg loss following treatment with adefovir in lamivudine-resistant patients. These results may provide useful information for the optimal timing of adefovir rescue as well as for better monitoring after treatment.
authors.affiliation: Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Sang Bok
authors.initials: SB
authors.lastname: Cha
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C053001:adefovir; D000225:Adenine