A higher alanine aminotransferase level correlates with earlier hepatitis B e antigen seroconversion in lamivudine-treated chronic hepatitis B patients

Authors

  • Tai-Chung Tseng,

    1. Department of Internal Medicine, Division of Hepatogastroenterology, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei, Taiwan
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  • Chun-Jen Liu,

    1. Department of Internal Medicine, Division of Gastroenterology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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  • Chia-Chi Wang,

    1. Department of Internal Medicine, Division of Hepatogastroenterology, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei, Taiwan
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  • Pei-Jer Chen,

    1. Department of Internal Medicine, Division of Gastroenterology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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  • Ming-Yang Lai,

    1. Department of Internal Medicine, Division of Gastroenterology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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  • Jia-Horng Kao,

    1. Department of Internal Medicine, Division of Gastroenterology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    3. Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    4. Department of Medical Research, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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  • Ding-Shinn Chen

    1. Department of Internal Medicine, Division of Gastroenterology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
    2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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Correspondence
Prof. Jia-Horng Kao, Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, 1 Chang-Te Street, Taipei 10002, Taiwan
Tel: +886 2 2312 3456 (ext) 7307
Fax: +886 2 2382 5962
e-mail: kaojh@ntu.edu.tw

Abstract

Background/Aims: A pretherapy serum alanine aminotransferase (ALT) level above five times the upper limit of normal (ULN) is known to predict hepatitis B e antigen (HBeAg) seroconversion during lamivudine therapy for chronic hepatitis B patients. However, whether an even higher pretherapy serum ALT value or other viral factors could affect treatment responses remains unclear.

Patients and methods: A total of 253 HBeAg-positive chronic hepatitis B patients who had a pretherapy serum ALT level over five times ULN and received lamivudine for 12–18 months were retrospectively collected. Among these patients, 38% had received prior lamivudine treatment. HBeAg seroconversion was the primary endpoint of treatment. Baseline clinical and viral features were compared between responders and non-responders at the end of treatment and 6 months post-treatment.

Results: At the end of therapy, the overall HBeAg seroconversion rate was 33.6%. For lamivudine-naïve patients, the HBeAg seroconversion rate was 37.8%. Subgroup analysis showed that patients with pretherapy ALT levels over 10 times ULN had a significantly higher HBeAg seroconversion rate than those with a pretherapy ALT level between five and 10 times ULN at 3 months (P=0.045) and 6 months (P=0.037) of lamivudine treatment. No significant difference was found in terms of pretherapy serum ALT values, viral load and genotypes between seroconverters and non-seroconverters.

Conclusions: For lamivudine-treated HBeAg-positive patients with pretherapy ALT levels over five times ULN, an even higher ALT level could predict earlier HBeAg seroconversion; however, neither ALT levels nor viral factors correlate with higher response rates after 12–18 months of treatment.

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