HBeAg Loss Is Predicted by HBV DNA Early Kinetics

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and HBV Genotype During Treatment with Hepsera (adefovir dipivoxil) Researchers at Bar-Ilan University in Ramat-Gan, Israel conducted this study to identify predictors of HBeAg loss during antiviral therapy of HBeAg+ CHB patients with Hepsera (adefovir [ADV]) 10mg/day. 129 patients were treated for 48 weeks with Hepsera (adefovir dipivoxil [ADV]) 10mg/day. HBV DNA was monitored every 4 weeks (Roche Amplicor). HBV DNA at week 1 was estimated by log-linear regression. Viral kinetics patterns were classified and correlated with HBeAg loss and baseline factors. 128/129 ADV patients had a rapid viral decline (mean 1.8 log) during the first week. After this, two major patterns were identified: a flat second phase (<0.05 log/week) during weeks 4-48 (RF) or a slow second phase decline (0.15 log/week) (RS) in 35% and 65% of patients, respectively. This slow second phase was then followed by three different third phases: HBV DNA became undetectable (<400 copies/ml) (RSBD) in 37% or reached a flat third phase (RSF; 35%) or had a staircase pattern (RSFS; 28%). Kinetics were identical between genotypes except more genotype C patients were RSBD. No RF patients lost HBeAg, compared to 28%, 43% and 77% of the RSF, RSFS and RSBD groups. Threshold HBV DNA levels at HBeAg loss were lower for genotype C patients, higher for ADV patients who were anti-HBe+ at the time of HBeAg loss and lower in ADV patients than placebo. Conclusions: HBV DNA kinetics during ADV therapy shows different patterns that can be used to predict eAg loss. A flat second phase has a strong negative predictive value for loss of HBeAg. The HBV DNA threshold for HBeAg loss depends on genotype, antibody and antiviral effect. 03/21/03 Reference AU Neumann and others. PREDICTING HBEAG LOSS BY HBV DNA EARLY KINETICS AND HBV GENOTYPE DURING TREATMENT OF HBEAG+ CHRONIC HEPATITIS B (CHB) PATIENTS WITH ADEFOVIR DIPIVOXIL (ADV). Abstract 3686.00. Abstracts of the 38th Annual Meeting of the European Association of the Study of the Liver (EASL).