A higher alanine aminotransferase level correlates with earlier hepatitis B e antigen seroconversion

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http://www.blackwell-synergy.com/doi/abs/10.1111/j.1478-3231.2008.01766.x

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doi:10.1111/j.1478-3231.2008.01766.x

Abstract

CLINICAL STUDIES

A higher alanine aminotransferase level correlates with earlier hepatitis B e

antigen seroconversion in lamivudine-treated chronic hepatitis B patients

Tai-Chung Tseng11 Department of Internal Medicine, Division of

Hepatogastroenterology, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei,

Taiwan, Chun-Jen Liu2,32 Department of Internal Medicine, Division of

Gastroenterology, National Taiwan University College of Medicine and National

Taiwan University Hospital, Taipei, Taiwan3 Graduate Institute of Clinical

Medicine, National Taiwan University College of Medicine and National Taiwan

University Hospital, Taipei, Taiwan, Chia-Chi Wang11 Department of Internal

Medicine, Division of Hepatogastroenterology, Buddhist Tzu Chi General Hospital

Taipei Branch, Taipei, Taiwan, Pei-Jer Chen2,32 Department of Internal Medicine,

Division of Gastroenterology, National Taiwan University College of Medicine and

National Taiwan University Hospital, Taipei, Taiwan3 Graduate Institute of

Clinical Medicine, National Taiwan University College of Medicine and National

Taiwan University Hospital, Taipei, Taiwan, Ming-Yang Lai2,32 Department of

Internal Medicine, Division of Gastroenterology, National Taiwan University

College of Medicine and National Taiwan University Hospital, Taipei, Taiwan3

Graduate Institute of Clinical Medicine, National Taiwan University College of

Medicine and National Taiwan University Hospital, Taipei, Taiwan, Jia-Horng

Kao2,3,4,52 Department of Internal Medicine, Division of Gastroenterology,

National Taiwan University College of Medicine and National Taiwan University

Hospital, Taipei, Taiwan3 Graduate Institute of Clinical Medicine, National

Taiwan University College of Medicine and National Taiwan University Hospital,

Taipei, Taiwan4 Hepatitis Research Center, National Taiwan University College of

Medicine and National Taiwan University Hospital, Taipei, Taiwan5 Department of

Medical Research, National Taiwan University College of Medicine and National

Taiwan University Hospital, Taipei, Taiwan and Ding-Shinn Chen2,32 Department of

Internal Medicine, Division of Gastroenterology, National Taiwan University

College of Medicine and National Taiwan University Hospital, Taipei, Taiwan3

Graduate Institute of Clinical Medicine, National Taiwan University College of

Medicine and National Taiwan University Hospital, Taipei, Taiwan1 Department of

Internal Medicine, Division of Hepatogastroenterology, Buddhist Tzu Chi General

Hospital Taipei Branch, Taipei, Taiwan

2 Department of Internal Medicine, Division of Gastroenterology, National Taiwan

University College of Medicine and National Taiwan University Hospital, Taipei,

Taiwan

3 Graduate Institute of Clinical Medicine, National Taiwan University College of

Medicine and National Taiwan University Hospital, Taipei, Taiwan4 Hepatitis

Research Center, National Taiwan University College of Medicine and National

Taiwan University Hospital, Taipei, Taiwan

5 Department of Medical Research, National Taiwan University College of Medicine

and National Taiwan University Hospital, Taipei, Taiwan

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@...

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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