Combination of baseline parameters and on-treatment hepatitis B virus DNA levels to start and continue patients with lamivudine therapy.
BACKGROUND
This study aimed to identify the baseline hepatitis B virus (HBV) DNA, alanine aminotransferase (ALT) levels and on-treatment HBV DNA levels for favourable outcome in patients receiving 5-year lamivudine.


METHODS
Virological, serological and biochemical parameters were assessed in 74 hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients at year 5 of therapy.


RESULTS
Patients with baseline HBV DNA levels <9 log(10) copies/ml and ALT> or =2x the upper limit of normal (ULN) had a significantly higher chance of HBV DNA suppression to <4 log(10) copies/ml (76.5%) and HBeAg seroconversion (82.4%), and a lower chance of YMDD mutations (35.3%) compared with patients with HBV DNA<9 log(10) copies/ml and ALT<2xULN and patients with HBV DNA> or =9 log(10) copies/ml (all P<0.05). All patients with these two baseline parameters plus week 4 HBV DNA<4 log(10) copies/ml achieved HBV DNA<35 copies/ml, HBeAg seroconversion and ALT normalization without YMDD mutations at year 5. When these two baseline parameters were combined with week 24 HBV DNA<3 log(10) copies/ml, 60%, 80% and 90% of patients had HBV DNA<35 copies/ml, <3 log(10) copies/ml and <4 log(10) copies/ml, respectively at year 5. Overall, 90% of patients had HBeAg seroconversion and only 10% had YMDD mutations.


CONCLUSIONS
For HBeAg-positive patients with baseline HBV DNA<9 log(10) copies/ml and ALT> or =2xULN, lamivudine could be initiated. For those with HBV DNA<4 log(10) copies/ml at week 4 or <3 log(10) copies/ml at week 24, continuation of lamivudine treatment would be more likely to result in a good long-term response.
Yuen
Man-Fung
MF
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. mfyuen@hkucc.hku.hk
Fung
James
J
Seto
Wai-Kay
WK
Wong
Danny Ka-Ho
DK
Yuen
John Chi-Hang
JC
Lai
Ching-Lung
CL
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000410:Alanine Transaminase