Natural course and response to interferon of chronic hepatitis B accompanied by antibody to hepatitis B e antigen

Abstract

The course of chronic hepatitis B was studied in 30 patients who had antibody to hepatitis e antigen and hepatitis B virus DNA in the serum and hepatitis B core antigen in the liver. Over a 2-year period, no patient experienced a sustained spontaneous remission of disease, and follow-up liver histology revealed worsening of the disease in four patients. After 2 years of observation, 24 patients were allocated randomly to one of two groups: 12 patients served as untreated controls and 12 received recombinant human alpha-interferon-2a in a dose of 9 million units intramuscularly three times weekly for 16 weeks. Patients who remained viremic after 16 weeks received 3 million units three times weekly for an additional 8 weeks. Abnormal amino-transferases and serum hepatitis B virus DNA persisted without appreciable changes in all untreated patients. Hepatitis B virus DNA rapidly became undetectable and serum aminotransferases fell to normal in eight treated patients. After the end of treatment, hepatitis B virus DNA became detectable once again in seven patients, in six of whom a peak of aminotransferases (range: 256 to 850 units per liter) ensued; subsequently, hepatitis B virus DNA disappeared, and serum aminotransferases again fell to normal in two of the seven. Overall, hepatitis B virus DNA was no longer detectable in serum and liver histology improved in three treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…8,10,19,20 Other studies have shown higher on-treatment and sustained response rates. [30][31][32] Sustained response to lamivudine posttreatment is currently under evaluation.…”

“…Sustained suppression of HBV replication and normalization of ALT may be associated with important clinical benefits in patients with precore mutant chronic hepatitis B who undergo frequent fluctuations in levels of viremia and serum ALT. 10 Previous studies have shown that the persistence of detectable serum levels of HBV DNA and marked fluctuations in serum ALT are associated with an increased risk of cirrhosis. 11,12 Brunetto et al 10 studied the natural course of chronic hepatitis B in anti-HBe-positive patients and showed spontaneous remissions of disease to be infrequent.…”

“…10 Previous studies have shown that the persistence of detectable serum levels of HBV DNA and marked fluctuations in serum ALT are associated with an increased risk of cirrhosis. 11,12 Brunetto et al 10 studied the natural course of chronic hepatitis B in anti-HBe-positive patients and showed spontaneous remissions of disease to be infrequent. None of 30 patients followed for 2 years had sustained remission of disease.…”

“…8,9 The persistence of viremia in patients with precore mutant HBV infection is frequently accompanied by persistent or intermittent elevations in serum aminotransferases. 8,10 This often leads to the complications of progressive liver disease including cirrhosis and hepatocellular carcinoma. 11,12 Precore mutant chronic hepatitis B exists world wide but is particularly common in Mediterranean Europe and in Asia.…”

“…17,18 Several studies have shown that the presence of precore mutations correlates with suboptimal responses to interferon therapy and is associated with a high rate of relapse. 8,10,19,20 Furthermore, alfa-interferon must be given by subcutaneous injection and has potentially doselimiting side effects. Therefore, there is clearly a need to evaluate alternative therapies for this group of chronic hepatitis B patients.…”