Viral Hepatitis
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2005; 11(22): 3346-3350
Published online Jun 14, 2005. doi: 10.3748/wjg.v11.i22.3346
Effect of lamivudine in HBeAg-positive chronic hepatitis B: Discordant effect on HBeAg and HBV DNA according to pretreatment ALT level
Tomoko Kurihara, Fumio Imazeki, Osamu Yokosuka, Kenichi Fukai, Tatsuo Kanda, Shigenobu Kawai, Hiromitsu Saisho
Tomoko Kurihara, Fumio Imazeki, Osamu Yokosuka, Kenichi Fukai, Tatsuo Kanda, Shigenobu Kawai, Hiromitsu Saisho, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou Ward, Chiba 260-8670, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Osamu Yokosuka, MD, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou Ward, Chiba 260-8670, Japan. yokosukao@faculty.chiba-u.jp
Telephone: +81-43-226-2086 Fax: +81-43-226-2088
Received: September 13, 2004
Revised: September 14, 2004
Accepted: October 8, 2004
Published online: June 14, 2005
Abstract

AIM: To clarify differences in antiviral effect of the drug in patients with different ALT levels, we examined the changes in HBV markers in patients with high or low ALT levels with or without lamivudine treatment.

METHODS: Thirty-seven HBeAg-positive patients were studied. Ten patients with ALT levels higher than 200 IU/L (group 1) and 8 patients with ALT below 200 IU/L (group 2) were treated orally with 100 mg/d of lamivudine. As untreated control, 9 patients with ALT above 200 IU/L (group 3) and 10 patients with ALT below 200 IU/L (group 4) were examined. ALT level, HBeAg/HBeAb status, and HBV DNA level were examined monthly for 11.9±0.4 mo.

RESULTS: The ALT level normalized in all 10 patients of group 1, 7/8 of group 2, 4/9 of group 3, and 1/10 of group 4 within 6 mo (groups 1 vs 2, P = NS; groups 1 vs 3, P = 0.002; groups 1 vs 4, P<0.0001). HBV DNA fell below the detection limit in all 10 patients of group 1, 7/8 of group 2, 0/9 of group 3, and 0/10 of group 4 within 6 mo (groups 1 vs 2, P = NS). HBeAg became seronegative in 7/10 patients of group 1, 1/8 of group 2, 3/9 of group 3, and 0/10 of group 4 within 12 mo (groups 1 vs 2, P = 0.02; groups 1 vs 3, P = NS).

CONCLUSION: Our data suggest that HBeAg-positive patients with higher ALT levels can be considered good candidates for lamivudine therapy, probably because lamivudine accelerates the natural seroconversion of HBeAg, accompanied by HBV DNA loss, in these patients.

Keywords: Lamivudine, Chronic hepatitis B, HBeAg, HBV DNA, ALT