Effect of lamivudine in HBeAg-positive chronic hepatitis B: Discordant effect on HBeAg and HBV DNA according to pretreatment ALT level

[Change of HBV DNA level as a predictor of HBeAg loss after lamivudine treatment]

BACKGROUND AND AIMS

Lamivudine is an effective, safe therapeutic agent for the treatment of chronic hepatitis B. The aim of this study was to investigate whether early suppression of the viral load predicts HBeAg loss within 1 year during lamivudine therapy.

METHODS

This prospective study encompassed 74 patients (mean age: 37.1 years, male/female: 51/23) who were positive HBeAg, their AST or ALT levels were > or =2 times the upper limit of normal and their HBV DNA was > or =10(5) copies/mL. The patients received lamivudine 100 mg for 12 months with monitoring their HBV DNA, AST, ALT, HBeAg and anti-HBe, and all these tests were performed at pretreatment and 1, 3, 6, 9 and 12 months after treatment. The serum HBV DNA was measured by HBV branched DNA assay.

RESULTS

HBeAg loss was observed in 12 patients (16.2%), and 9 patients achieved anti-HBe seroconversion during up to 1 year of lamivudine therapy. The mean time to HBeAg loss was 5.6 months (range: 1-12 months). The posttreatment HBV DNA (<2,000 copies/mL) after 3 month (P=0.008) and 6 month (P=0.012)) were significant predictors of HBeAg loss after 1 year of lamivudine treatment on univariate analysis. Pretreatment HBV DNA, AST/ALT, gender, age and liver cirrhosis had no impact on HBeAg loss. The six-month posttreatment HBV DNA level <2,000 copies/mL was a significant predictor of HBeAg loss on multivariate analysis (P=0.008, odds ratio=0.108).

CONCLUSION

We suggest that an HBV DNA level <2,000 copies/mL at 6 month after lamivudine therapy is the most important predictor of HBeAg loss during up to 1 year of lamivudine therapy.

Relationship between liver pathologic histology and levels of serum hepatitis B virus DNA in patients with HBeAg-positive and -negative chronic hepatitis B

AIM: To investigate the relationship between serum hepatitis B virus (HBV) DNA levels and the inflammatory degrees of liver tissues in patients with HBeAg-positive and -negative chronic hepatitis B.

METHODS: HBV DNA level was assayed by fluorescent quantitative polymerase chain reaction (FQ-PCR) in 331 patients (230 HBeAg positive and 101 HBeAg negative). Liver biopsy was performed and the grading and staging of liver tissues were routinely obtained.

RESULTS: There was not obvious correlation between serum HBV DNA level and the grading and staging of liver tissues in 331 patients with chronic hepatitis B. Of the 101 patients with negative HBeAg, 31 cases were with more than 10⁸ copies/L HBV DNA, and there was significant correlation between HBV DNA level and the grading of tissues (r = 0.271, P < 0.005). A significant inverse correlation was demonstrated between HBV DNA level and hepatitis activity in the 230 patients with positive HBeAg (r = -0.659, P < 0.001).

CONCLUSION: The serum level of HBV DNA can help to assess the degrees of hepatitis activity in patients with negative HBeAg. In HBeAg-positive patients, the serum level of HBV DNA is negatively correlate with hepatic activity index.