The role of serum hepatitis B surface antigen (HBsAg) level in determining
virological breakthrough (VB) for patients with hepatitis B virus (HBV)
infection receiving lamivudine remains unclear. We aimed to evaluate the
impact of serum HBsAg levels on VB among patients receiving lamivudine
therapy, especially in a setting of low HBV viral load.
Methods
We enrolled 268 consecutive treatment-naïve patients who underwent
lamivudine therapy for chronic hepatitis B (CHB). Factors in terms of VB
were analyzed by multivariate analysis.
Results
After a median treatment duration of 67.1 weeks, 102 patients had VB.
Multivariate analysis showed that positive hepatitis B e antigen (HBeAg)
(Hazard ratio, HR 2.179, p=0.012) and HBV DNA levels ≥2000 IU/mL after 6
months of lamivudine therapy (HR 5.460, p<0.001) were independent risk
factors predicting VB. The cumulative VB rates stratified by HBeAg positive
and negative at 3 years were 44.7% and 26.3%, respectively. At 3 years,
the cumulative VB rates stratified by the HBV DNA <2000 and ≥2000 IU/mL
after 6 months of therapy were 25.5% and 79.4%, respectively. For
HBeAg-positive patients with serum HBV DNA <2000 IU/mL after 6 months of
therapy, baseline HBsAg levels ≥20000 IU/mL was the only risk factor
associated with VB.
Conclusions
For CHB patients treated with lamivudine, serum HBV DNA level>2000 IU/mL
after 6 months of therapy could predict subsequent VB. In patients with
lower on-treatment viral load, baseline serum HBsAg level is associated
with the emergence of VB, especially for those with serum positive HBeAg. 作者: StephenW 时间: 2013-6-13 12:40