Decrease in viral load at weeks 12 and 24 in patients with chronic hepatitis B treated with lamivudine or adefovir predicts virological response at week 48 En pacientes con hepatitis crónica B tratados con lamivudina y adefovir el descenso de la viremia en las semanas 12 y 24 tiene valor predictivo de respuesta virológica

Abstract

Aim: the aim of our study was to evaluate the decrease in viral load (VL) that is able to predict antiviral treatment response at one year in patients with chronic hepatitis B. Methods: the clinical records of 66 patients, 31 treated with lamivudine (LAM) and 35 treated with adefovir (ADF), were retrospectively reviewed. We measured viral DNA at months 1, 3 and 6. Results: the LAM group showed virological response (VR) in 51.6% of patients. Baseline VL was higher in non responders (5.37 ± 1.16 vs. 7.01 ± 1.05; p < 0.001). Responders showed a higher percentage of VL decrease at month 3 from baseline (49.2 vs. 38.3%; p = 0.03). We designed a ROC curve and established a cutoff point for decrease of 30% that had 80% of negative predictive value (NPV). The ADF group showed VR in 57.1% of patients. Baseline VL was higher in nonresponders (4.67 ± 1.22 vs. 5.78 ± 1.34; p = 0.01). We observed a significant decrease in VL (log) at months 3 (2.6 ± 1.1 vs. 1.3 ± 1.3; p = 0.03) and 6 (2.6 ± 1.2 vs. 1.3 ± 1.2; p = 0.006). The percentage of decrease of VL from baseline was also statistically significant. We created ROC curves at months 3 and 6, and established the best cutoff points. At month 6 a decrease of 1 log in VL had a NPV of 80%, and a decrease of 20% in VL from baseline had 100% NPV. Conclusion: the decrease in viral DNA at weeks 12 and 24 can predict VR at one year in patients with chronic hepatitis B treated with LAM or ADF. This could optimize treatment.

Keywords

• Adefovir
• Lamivudine
• Chronic hepatitis B
• Virological response