High rate of early posttreatment relapse in chronic hepatitis B (CHB) patients (pts) with HBeAg seroconversion after lamivudine treatment

초록

Background: It has been reported that relapses are frequent after cessation of the treatment in Korean CHB pts with HBeAg seroconversion after lamivudine treatment, but characteristics of relapses such as rate, time, and predictive factors were uncertain. Fifty-eight Korean CHB patients with HBeAg loss after lamivudine treatment were followed up monthly for first 3 months and then 3-4 times yearly after cessation of the treatment until relapse. Results: Twenty-seven pts relapsed (HBV DNA + ve with raised ALTs, Cumulative relapse rate: 72%) and median duration of the study period was 3 mo (range 0-26 mo.) because of early relapse. Relapses occurred within 6 mo in 26 of 27 pts. In the 31 unrelapsed cases, 12 cases were followed up longer than 6 mo. and none of them did not relapse except one (relapsed at 7 mo.). HBeAg reappeared in 14 and the other (n = 13) were HBeAg-ve relapses.. There were no statistical differences in age, sex, pre-treatment HBV DNA titer, serum albumin, ALTs, total bilirubin, and presence of anti-HBe after HBeAg loss between relapsed cases and 11 cases with durable response, except for pretreatment platelet counts. Pretreatment platelet counts were significantly lower in relapsed cases compared with cases with durable response (p = 0.025). Twelve-two relapsed pts including 3 with jaundice were retreated and they showed an excellent response, but all 6 retreated pts (3 HBeAg + ve and 3 HBeAg-ve, retreatment 6-15 mo.) who stopped lamivudine again, relapsed in 3-6 mo. after cessation. Conclusions: Cessation of lamivudine in pts with HBeAg loss after lamivudine treatment was accompanied by a high rate of early relapse in Korean pts with CHB and pretreatment peripheral blood platelet counts were significantly lower in relapsed cases. Long term durability may be predicted in the pts showing response at least longer than 6 months after cessation of lamivudine treatment and is less than 30% in Korean CHB pts.