title: Pretreatment alanine transaminase level may not be the most important predictor of HBeAg loss in the older patient.
abstract: BACKGROUND
  Elevated pretreatment alanine aminotransferase (ALT) over two times the upper limit of normal reference range has been accepted as a marker for predicting HBeAg loss and an indicator for initiating antiviral therapy. Recently, several opinions argued that in patients aged over 40 years, the treatment should be started if they have elevated serum hepatitis B virus (HBV) DNA without elevated ALT. However, initiating treatment in these patients might be argued against by the concept that the rate of HBeAg loss depends on the pretreatment ALT.
  
  
  OBJECTIVE
  This study was conducted to investigate the usefulness of pretreatment ALT in predicting HBeAg loss in patients aged over 40 years under lamivudine treatment.
  
  
  METHODS
  We retrospectively analyzed 820 HBeAg-positive patients treated with lamivudine. The patients with hepatocellular carcinoma at or after initiating the lamivudine treatment and patients with evident liver cirrhosis were excluded. Three hundred fifty-five patients met the criteria and were divided into two groups: </=40 years of age (Group 1) and >40 years of age (Group 2).
  
  
  RESULTS
  Analysis using the Kaplan-Meier method and the log rank test showed that the cumulative rate of HBeAg loss was not different in the two groups. Multivariate modelling indicated that an elevated pretreatment ALT level was a predictor of HBeAg loss in Group 1 (P<0.05), whereas it failed to act as a predictor in Group 2.
  
  
  CONCLUSIONS
  Antiviral therapy might not need to be deferred until the ALT level increases in order to enhance the chance of HbeAg loss in HBV DNA-(+) patients aged over 40 years.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Inha University College of Medicine, Incheon, Korea. mdflorence@inha.ac.kr
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Park
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Hyung Gil
authors.initials: HG
authors.lastname: Kim
authors.forename: Yong Woon
authors.initials: YW
authors.lastname: Shin
authors.forename: Kye Sook
authors.initials: KS
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood*; D006509:Hepatitis B / Q000097:blood* / Q000188:drug therapy; D006513:Hepatitis B e Antigens / Q000097:blood*; D006801:Humans; D007723:Korea; D019259:Lamivudine / Q000627:therapeutic use; D008875:Middle Aged; D008954:Models, Biological
chemical_list: D006513:Hepatitis B e Antigens; D019259:Lamivudine; D000410:Alanine Transaminase