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Different models of HBeAg seroconversion predicated by on‐treatment ALT and HBV DNA profiles
Author(s) -
You Hong,
Ma Hong,
Liu Tianhui,
Cong Min,
Wang Ping,
Ou Xiaojuan,
Wang Xiaoming,
Ren Jiangbo,
Li Hongyi,
Wang Baoen,
Jia Jidong
Publication year - 2009
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/j.1365-2893.2009.01145.x
Subject(s) - seroconversion , adefovir , medicine , telbivudine , entecavir , hbeag , lamivudine , gastroenterology , reversion , hepatitis b virus , hepatitis b , virology , immunology , hbsag , antibody , virus , biology , biochemistry , gene , phenotype
Summary. Pretreatment alanine transaminase (ALT) elevation may be used as a predictor for higher hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B patients. However, the role of dynamic changes of on‐treatment ALT for seroconversion is unknown. A total of 170 naïve HBeAg‐positive chronic hepatitis B patients were treated with a nucleoside/nucleotide analogues (NA), either lamivudine, adefovir, entecavir, or telbivudine, for at least 2 years and followed up for 1 more year. Clinical characteristics were detected and analysed at baseline and at 3‐month intervals. On‐treatment ALT predicted HBeAg seroconversion more accurately than baseline ALT. Among the patients with on‐treatment ALT ≤1 × UNL, 1–≤2 × UNL, 2–≤5 × UNL and >5 × UNL, HBeAg seroconversion was 11.4, 5.4, 24.4 and 65.0% (odds ratio = 1.0, 0.4, 2.5 and 14.4, respectively), respectively. Moreover, two models/types of seroconversion were observed. Type I was characterized by rapidly decreased ALT and HBV DNA during the first 3‐month interval, but with high HBeAg reversion rate (50%) after consolidation treatment. Type II was a slow decreased DNA procedure accompanied by significant elevated ALT with less reversion (23%). Receiver operating characteristic curve analysis showed a 1.9‐fold increased ALT ratio (present visit ALT: previous visit ALT) accompanied by at least a 0.8 log decreased HBV DNA may be used to classify these two seroconversion types. We conclude that on‐treatment elevated ALT levels is a better predictor for seroconversion after NAs treatment, and HBV DNA profiles may help to identify different models of seroconversion.