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Using a multiphase bio-mathematical model, we studied the dynamics of hepatitis B virus (HBV) infection in 72 HBeAg-negative patients who received 48 weeks of either lamivudine (3TC; 25 patients); pegylated interferon-α2a (peg-IFN-α2a) 180 mg weekly plus 3TC (23 patients), or peg-IFN-α2a 180 mg weekly plus placebo (24 patients).    During the first month of therapy most of the 3TC -/+ peg-IFN-α2a treated patients showed a multiphase decay of viral load: during the first two phases, where we hypothesized a direct inhibition of virus production, the mean viral production per infected cell was reduced by 2.22 log 10  and 2.36 log 10 , respectively. At variance, peg-IFN-α2a treated patients had a biphasic profile: the first phase HBV DNA decline was slower than that observed in 3TC patients (mean HBV DNA t 1/2 =1.6 ±1.1 days and 9.5 ±3.0 h, respectively) and the direct antiviral effect reduced virus production by 1.14 log 10  From day 14 onwards (third or second phase according to multi- or biphasic patterns), HBV DNA declined mainly because of the infected hepatocyte clearance that slowed down in approximately 50% of the patients from day 35, possibly because of a negative feedback on the immune system activity. Computing the number of infected cells at the end of therapy we found that peg-IFN-α2a and 3TC monotherapy determined a similar reduction of infected hepatocytes (mean: -3.3 log 10 ), whereas there was a greater reduction in combination therapy patients (-5.0 versus -3.3 log 10 , P=0.039). In conclusion, peg-IFN-α2a, in spite of having direct antiviral activity lower than that of 3TC, achieved a comparable reduction of infected hepatocytes, possibly because of a higher infected cell clearance rate.

A Multiphase Model of the Dynamics of HBV Infection in Hbeag-Negative Patients during Pegylated Interferon-α2A, Lamivudine and Combination Therapy