[Treatment of chronic hepatitis B]

Pegylated interferon α enhances recovery of memory T cells in hepatitis B e antigen positive chronic hepatitis B patients

AIM: To investigate the change of peripheral CD8⁺ memory T lymphocyte subsets in hepatitis B e antigen positive patients with chronic hepatitis B (CHB) during peginterferon-alph 2b (PEG-IFNα-2b) treatment.

METHODS: Thirty hepatitis B e antigen positive patients with CHB were recruited and received PEG-IFNα-2b treatment for 24 wk. Before and at the 12^th and 24^th wk of treatment, flow cytometry was used to detect the peripheral CD8⁺ memory T lymphocyte subsets. Real-time PCR was used to detect the level of HBV DNA. Markers of hepatitis B virus infection were detected by ELISA assay, and serum level of alanine aminotransferase (ALT) was measured using an automatic biochemical analyzer.

RESULTS: Treatment for 24 wk with PEG-IFN-2b resulted in HBeAg seroconversion to negative in 6.7% patients, and the response rate was 36.7%. The response rate was significantly higher in patients with lower viral load (VL). At weeks 12 and 24, serum ALT levels in patients with CHB were significantly lower than pretreatment values. The level of HBV DNA and the percentage of naïve lymphocytes (T naïve) in patients with CHB at week 12 were significantly lower than pretreatment values, but there were no significant differences between at weeks 24 and 12. The percentages of central memory T cells (T_CM) and effector memory T cells (T_EM) increased gradually during PEG-IFNα-2b treatment. The levels of ALT and HBV DNA and the proportion of naïve T cells significantly decreased in the responders at 12 and 24 wk (P < 0.05), and the proportion of T_EM significantly increased at 12 and 24 wk (P < 0.05). The proportion of T_CM had no significant difference between the responders and non-responders at 12 wk (P > 0.05), but significantly increased in the responders at 24 wk (P < 0.05). T_TEM had no significant changes at different time points and in the responders.

CONCLUSION: PEG-IFNα-2b treatment enhances recovery of memory T cell subset in CHB patients by down-regulating naïve T cells and up-regulating effector cells. CD8⁺ memory T lymphocyte subsets may be used as biomarkers for predicting the outcome of treatment.

Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome.

Efficacy of consensus interferon in treatment of HbeAg-positive chronic hepatitis B: a multicentre, randomized controlled trial

Background

Consensus interferon (CIFN) is a newly developed type I interferon.

Aims

This multicentre, controlled trial was conducted to determine the efficacy of CIFN and to compare it with alpha-1b-interferon (IFN-α1b) in the treatment of patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B.

Methods

144 Patients were randomly assigned to receive 9 μg CIFN (CIFN group) or 50 μg INF-α1b (IFN-alpha group) subcutaneously 3 times weekly for 24 weeks, followed by 24 weeks of observation. Efficacy was assessed by normalization of serum alanine transaminase (ALT) levels and the non-detectability of serum hepatitis B virus DNA or HBeAg at the end of treatment and 24 weeks after stopping treatment.

Results

There was no statistically significant difference in the serological, virological and biochemical parameters between CIFN and IFN-α1b groups at the end of the therapy and follow-up period (p > 0.05). Overall, at the end of treatment, 7.0% (5/71) and 35.2% (25/71) of patients in the CIFN group showed a complete or partial response compared with 7.4% (5/68) and 33.8% (23/68) of the IFN-alpha group (p = 0.10). At 24 weeks after stopping treatment, 6.9% (5/72) and 37.5% (27/72) of patients in the CIFN group showed complete response or partial response compared with 7.1% (5/70) and 34.3% (24/70) of the IFN-alpha group (p = 0.10).

Conclusion

These findings suggest that 9 μg CIFN is effective in the treatment of patients with HBeAg-positive chronic hepatitis B. It can gradually induce ALT normalization and HBV DNA clearance and HBeAg loss or HBeAg/HBeAb seroconversion.