Optimization of adefovir therapy in chronic hepatitis B according to baseline predictors and on-treatment HBV DNA: a 5-Year prospective study

Virology Journal

Li Xian Ma³  Bing Lu²  Jing Yao Zhang¹  Fei Shen¹  Da Ying Geng¹  Hui Lu³ 

[1] Jinan Infectious Disease Hospital, affiliated to Shandong University, Jinan, China;Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA;Department of Infectious Diseases, Qilu Hospital of Shandong University, Jinan, China

关键词: predictor;    hepatitis Be antigen positive;    hepatitis B virus;    therapy;    Adefovir Dipivoxil;    chronic;    hepatitis B;   

Others  :  1156057
DOI  :  10.1186/1743-422X-8-444

 received in 2011-06-07, accepted in 2011-09-21,  发布年份 2011

【 摘 要 】

Background

Adefovir Dipivoxil (ADV) is an important agent to suppress hepatitis B virus (HBV) replication with suboptimal effect on virological and serological response. To optimize Adefovir therapy in chronic hepatitis B (CHB) patients with hepatitis B e antigen (HBeAg) positive, we studied the baseline parameters and on-treatment HBV DNA for favorable outcomes.

Methods

48 patients were enrolled in the study and followed up for 5 years prospectively. Baseline characteristics, virological, serological and biochemical parameters as well as on treatment HBV DNA were assessed in prediction of favorable outcomes.

Results

1. The patients with baseline alanine aminotransferase (ALT) ≥5 × the upper limit of normal (ULN, 40 IU/L) had higher rates of viral response (VR), HBeAg loss and HBeAg seroconversion at year 5 compared to the patients with ALT < 5 × ULN (VR: 75% vs 43.8%, p = 0.035; HBeAg loss: 43.9% vs 13.8%, p = 0.017; HBeAg seroconversion: 37.9% vs 13.8%, p = 0.035); Patients with baseline HBV DNA < 10⁹ copies/ml and ALT ≥3 × ULN had more chance of HBeAg seroconversion (40.9% vs 8.7%, p = 0.012), while in patients with HBeAg < 800 s/co or HBsAg < 5000 IU/ml higher rates of HBeAg loss were achieved. 2. HBV DNA level < 10⁴ copies/ml at week 24 was predictive for VR (96.0% vs 40.9%, P < 0.001), HBeAg loss (84.0% vs 36.3%, P = 0.001) and HBeAg seroconversion (36.0% vs 9.1%, P = 0.030).

Conclusions

ADV treatment should be started for patients with baseline ALT≥5 × ULN or patients with ALT≥3 × ULN and HBV DNA < 10⁹ copies/ml. Lower level of HBeAg(< 800 s/co) and HBsAg(< 5000 IU/ml) may be regarded as referenced factors. In patients with serum HBV DNA < 10⁴ copies/ml at week 24 the therapy should continue, and a favorable outcome may be achieved in 5 years or longer.

【 授权许可】

   
2011 Lu et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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