Lamivudine: Sustained HBeAg...

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HEPATOLOGY
November 2003 . Volume 38 . Number 5
Original Articles: Viral Hepatitis

Determinants for sustained HBeAg response to lamivudine therapy

Rong-Nan Chien ,Chau-Ting Yeh [MEDLINE LOOKUP]
Sun-Lung Tsai ,Chia-Ming Chu ,Yun-Fan Liaw

   Abstract
There are inconsistent data on the durability of hepatitis B e antigen
(HBeAg) seroconversion after lamivudine is discontinued. The aim of this
study was to examine the determinants for sustained HBeAg response to
lamivudine therapy. Both host and viral factors as well as the drug factor
were compared between 43 patients with sustained HBeAg response and 39
patients whose response was not sustained. All of them received a mean
period of 16 months (range, 3-55 months) lamivudine therapy and had achieved
complete response (HBeAg seroconversion plus HBV DNA seroclearance by hybrid
capture assay and normal alanine aminotransferase [ALT]) and were
followed-up for a mean period of 44 months (range, 12-88 months). Stepwise
logistic regression model was used to estimate the sustained response on the
presence of the following variables: age; gender; pretherapy ALT; total
bilirubin and HBV DNA levels; time to HBeAg seroconversion; additional
lamivudine treatment after HBeAg seroconversion; total duration of
treatment; hepatitis activity index scores; periportal, intralobular, and
portal inflammation and fibrosis scores; scores excluding fibrosis; status
of precore mutation; basal core promoter mutation; and genotype. The results
showed that genotype (OR, 5.922; 95% CI, 1.611-21.768; P = .007), age (OR,
0.943; 95% CI, 0.891-0.997; P = .040), and additional treatment (OR, 1.097;
95% CI, 1.028-1.171; P = .005) were independent factors to sustained HBeAg
response. Further categorical analysis disclosed that patients with genotype
B, age 36 years, and additional lamivudine treatment over 8 months have
higher sustained response. In conclusion, HBV genotype, age, and additional
treatment are the major determinants for the sustained HBeAg response to
lamivudine therapy.
(HEPATOLOGY 2003;38:1267-1273.)

   Publishing and Reprint Information
From the Liver Research Unit, Chang Gung Memorial Hospital and University,
Taipei, Taiwan.
Received May 20, 2003.
Accepted August 7, 2003.
Supported in part by grants from the National Science Council (NSC
89-2315-B-182A-008-MH) and Prosperous Foundation, Taiwan.
R.-N.C.'s current address is 222 Mai-Chin Road, Keelung, Taiwan.
S.-L.T.'s current address is 901 Chung Hwa Road, Young Kang City, Tainan
County, Taiwan.
Address reprint requests to: Rong-Nan Chien, M.D., Liver Research Unit,
Chang Gung University and Memorial Hospital, 222 Mai Chin Road, Keelung,
Taiwan 204. E-mail: [email protected] ; fax: (886) 2-24335342.
Copyright © 2003 by the American Association for the Study of Liver
Diseases.
0270-9139/03/3805-0025$30.00/0
doi:10.1053/jhep.2003.50458