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Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2007; 13(30): 4085-4090
Published online Aug 14, 2007. doi: 10.3748/wjg.v13.i30.4085
Baseline HBV DNA level is the most important factor associated with virologic breakthrough in chronic hepatitis B treated with lamivudine
Hee Bok Chae, Hie-Won Hann
Hee Bok Chae, Hie-Won Hann, Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Department of Medicine, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
Hee Bok Chae, Department of Internal Medicine, College of Medicine and Medical Institute, Chungbuk National University, Cheongju 362-711, South Korea
Author contributions: All authors contributed equally to the work.
Supported by the research grant of the Chungbuk National University in 2004
Correspondence to: Hie-Won Hann, Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Department of Medicine, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States. hie-won.hann@jefferson.edu
Telephone: +1-215-9555806 Fax: +1-215-9550770
Received: May 16, 2007
Revised: May 23, 2007
Accepted: June 4, 2007
Published online: August 14, 2007
Abstract

AIM: To identify the factors associated with virologic breakthrough and to select a subgroup of patients who respond well to lamivudine without developing virologic breakthrough (VBT).

METHODS: Of 79 patients who had received lamivudine therapy for 9-57 mo, 34 were HBeAg-positive and 45 were HBeAg-negative, 24 developed virologic breakthrough and 55 did not. Clinical and virologic factors were compared between the two groups.

RESULTS: The median duration of therapy was 25 (9-57) mo. Virologic breakthrough was defined as a > 1 log HBV DNA increase following initial suppression. When several factors, including gender, duration of infection, baseline HBV DNA, and baseline ALT in HBeAg-positive chronic hepatitis patients were analyzed by logistic regression, the most important predictor of virologic breakthrough was the baseline HBV DNA (r2 = 0.12, P < 0.05). When HBeAg-postitive chronic hepatitis patients were divided into two groups by a point of 6.6 log HBV DNA, the incidence of virologic breakthough between two groups was significantly different.

CONCLUSION: Lamivudine may remain an effective first line therapy for those HBeAg-positive patients with a baseline HBV DNA < 6.6 log10 copies/mL.

Keywords: Hepatitis B; Lamivudine; Virologic breakthrough; HBV DNA