Early response to lamivudine therapy in clinically non-cirrhotic chronic hepatitis B patients with decompensation

Authors

  • Chia-Yen Dai,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    3. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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  • Ming-Lung Yu,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Ming-Yen Hsieh,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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  • LI-Po Lee,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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  • Nai-Jen Hou,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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  • Jee-Fu Huang,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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  • Shinn-Cherng Chen,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Zu-Yau Lin,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Ming-Yuh Hsieh,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Liang-Yen Wang,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Jun-Fa Tsai,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Wen-Yu Chang,

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. College of Medicine, Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Wan-Long Chuang

    1. Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    2. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Correspondence
Wan-Long Chuang, MD, PhD, Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Rd, Kaohsiung 807, Taiwan
Tel: +886 7 3121101 ext., 7475
Fax: +886 7 3234553
e-mail: d820195@yahoo.com.tw, d820195@gmial.com

Abstract

This study aimed to elucidate the rate and predictors of early (6 months) therapeutic responses to lamivudine, the rate of early mortality and the use of the model for end-stage liver disease (MELD) and Index in predicting the survival in patients with a clinical diagnosis of non-cirrhotic chronic hepatitis B with decompensation. Ninety-eight patients with lamivudine therapy were enrolled and MELD and Index scores were calculated. Surviving patients were treated with lamivudine for more than 6 months. Four (4.1%) of the 98 patients died after initiation of lamivudine therapy. After a 6-month lamivudine therapy, 80 (85.1%) patients and 71 (75.5%) patients had normal alanine aminotransferase (ALT) values and negative hepatitis B virus (HBV) DNA (<200 copies/mL), respectively, and hepatitis B e antigen (HBeAg)-negative patients had a significantly higher rate of negative HBV DNA than HBeAg-positive patients (P=0.002). The rates of HBeAg seroconversion and negative HBV DNA were 28.8 and 63.5%, respectively, and patients with HBeAg seroconversion had a significantly higher rate of negative HBV DNA (P=0.004). By multivariate analyses, older age, HBV nongenotype B infection, negative HBeAg and higher ALT levels were factors associated with negative HBV DNA, and a higher ALT level was associated with HBeAg seroconversion at month 6 after lamivudine therapy. MELD score and Index score were significantly associated with death and areas under the receiver operating characteristic curve for predicting survival were 0.936 and 0.907 respectively. We concluded that after 6-month lamivudine therapy, the patients who survived achieved favourable biochemical, virological responses and rate of HBeAg seroconversion. Both MELD and Index scoring systems are good models to predict the 6-month survival.

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