Chonnam Med J.  2008 Apr;44(1):37-42. 10.4068/cmj.2008.44.1.37.

Predictors of Response to Lamivudine Treatment in Children with Chronic Hepatitis B

Affiliations
  • 1Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. pedkjs@uuh.ulsan.kr

Abstract

Lamivudine, an oral nucleoside analogue, is a potent inhibitor of hepatitis B virus (HBV) replication. The decision to initiate therapy should be based on variables which are predictive of lamivudine-induced HBeAg loss. The aim of this study was to identify the predictive factors of responsiveness to lamivudine treatment in children with chronic hepatitis B. Lamivudine, 3 mg/kg/day (maximum, 100 mg/day), was given to 39 children with chronic HBV infection for more than 6 months. We retrospectively analyzed the effects of baseline factors on virologic response, which was defined as the loss of HBeAg and HBV DNA after cessation of therapy. Univariate and multivariate analyses examined the effects of lamivudine treatment, age, gender, duration of treatment, previous interferon therapy, maternal HBsAg state, baseline alanine aminotransferase (ALT) and HBV DNA level. Serum HBeAg and HBV DNA became negative in 20 (51.3%) out of 39 children at the time of cessation of lamivudine treatment. In the univariate analysis, higher baseline ALT and lower HBV DNA level were independently associated with a favorable response to lamivudine treatment (p<0.05). Multivariate regression analysis showed that elevated baseline ALT was the best independent predictor of response to lamivudine treatment (p<0.05). Virologic response of lamivudine could be expected in the half of children with chronic HBV infection. Children with elevated pretreatment ALT levels were most likely to respond to lamivudine treatment.

Keyword

Chronic Hepatitis B; Lamivudine; Child

MeSH Terms

Alanine Transaminase
Child
DNA
Hepatitis B e Antigens
Hepatitis B Surface Antigens
Hepatitis B virus
Hepatitis B, Chronic
Hepatitis, Chronic
Humans
Interferons
Lamivudine
Multivariate Analysis
Retrospective Studies
Alanine Transaminase
DNA
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Interferons
Lamivudine

Cited by  1 articles

Strategy to Overcome Drug Resistance That Develops during Treatment of Chronic Hepatitis B in Children
Suk Jin Hong, Byung-Ho Choe
Pediatr Gastroenterol Hepatol Nutr. 2012;15(2):63-73.    doi: 10.5223/pghn.2012.15.2.63.


Reference

1. Sokal EM, Kelly DA, Mizerski J, Badia IB, Areias JA, Schwarz KB, et al. Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B. Hepatology. 2006. 43:225–232.
Article
2. Joo KR, Bang SJ, Song BC, Youn KH, Joo YH, Yang S, et al. Hepatitis B viral markers of Korean adults in the late 1990s: survey data of 70,347 health screeners. Korean J Gastroenterol. 1999. 33:642–652.
3. Sim JG, Seo JK, Suh SJ. Prevalence and its changes of hepatitis B viral markers from 1988 to 1993 in Korean children. J Korean Pediatr Soc. 1995. 38:1535–1539.
4. Choe YH, Seo JK, Yun JH, Lee HS. Recent changes in prevalence of hepatitis B viral markers in preschool children in Seoul, 1995. Korean J Pediatr Soc. 1996. 39:1254–1259.
5. Hom X, Little NR, Gardner SD, Jonas MM. Predictors of virologic response to lamivudine treatment in children with chronic hepatitis B infection. Pediatr Infect Dis J. 2004. 23:441–445.
Article
6. Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988. 8:493–496.
Article
7. Sokal EM, Conjeevaram HS, Roberts EA, Alvarez F, Bern EM, Goyens P, et al. Interferon alfa therapy for chronic hepatitis B in children: a multinational randomized controlled trial. Gastroenterology. 1998. 114:988–995.
Article
8. Lok AS. Alpha-interferon therapy for chronic hepatitis B virus infection in children and oriental patients. J Gastroenterol Hepatol. 1991. 6:Suppl 1. S15–S17.
Article
9. Narkewicz MR, Smith D, Silverman A, Vierling J, Sokol RJ. Clearance of chronic hepatitis B virus infection in young children after alpha interferon treatment. J Pediatr. 1995. 127:815–818.
Article
10. Dienstag JL, Schiff ER, Wright TL, Perrillo RP, Hann HW, Goodman Z, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med. 1999. 341:1256–1263.
Article
11. Lok AS, McMahon BJ. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Chronic hepatitis B. Hepatology. 2001. 34:1225–1241.
12. Chien RN, Liaw YF, Atkins M. Pretherapy alanine transaminase level as a determinant for hepatitis B e antigen seroconversion during lamivudine therapy in patients with chronic hepatitis B. Asian Hepatitis Lamivudine Trial Group. Hepatology. 1999. 30:770–774.
Article
13. Perrillo RP, Lai CL, Liaw YF, Dienstag JL, Schiff ER, Schalm SW, et al. Predictors of HBeAg loss after lamivudine treatment for chronic hepatitis B. Hepatology. 2002. 36:186–194.
Article
14. Liaw YF. Management of patients with chronic hepatitis B. J Gastroenterol Hepatol. 2002. 17:406–408.
Article
15. Yao GB. Management of hepatitis B in China. J Med Virol. 2000. 61:392–397.
Article
16. Liaw YF, Chien RN, Yeh CT, Tsai SL, Chu CM. Acute exacerbation and hepatitis B virus clearance after emergence of YMDD motif mutation during lamivudine therapy. Hepatology. 1999. 30:567–572.
Article
17. Song BC, Suh DJ, Lee HC, Chung YH, Lee YS. Lamivudine therapy for chronic hepatitis B: efficacy, predictive factors for response and relapse rate after treatment. Korean J Med. 2000. 58:386–391.
18. Kweon YO, Kang KH. Pretreatment ALT level and histologic activity as predictors of HBeAg loss in lamivudine treatment for chronic hepatitis B. Korean J Hepatol. 2004. 10:31–41.
19. Hagmann S, Chung M, Rochford G, Jani M, Trinh-Shevrin C, Sitnitskaya Y, et al. Response to lamivudine treatment in children with chronic hepatitis B virus infection. Clin Infect Dis. 2003. 37:1434–1440.
Article
20. Jonas MM, Mizerski J, Badia IB, Areias JA, Schwarz KB, Little NR, et al. Clinical trial of lamivudine in children with chronic hepatitis B. N Engl J Med. 2002. 346:1706–1713.
Article
21. Honkoop , de Man RA, Niesters HG, Zondervan PE, Schalm SW. Acute exacerbation of chronic hepatitis B virus infection after withdrawal of lamivudine therapy. Hepatology. 2000. 32:635–639.
Article
22. Boni C, Bertoletti A, Penna A, Cavalli A, Pilli M, Urbani S, et al. Lamivudine treatment can restore T cell responsiveness in chronic hepatitis B. J Clin Invest. 1998. 102:968–975.
Article
23. Chang MH. Chronic hepatitis virus infection in children. J Gastroenterol Hepatol. 1998. 13:541–548.
Article
24. Lee PI, Chang MH, Lee CY, Hsu HY, Chen JS, Chen PJ, et al. Changes of serum hepatitis B virus DNA and aminotransferease levels during the course of chronic hepatitis B virus infection in children. Hepatology. 1990. 12:657–660.
Article
25. Zeuzem S, de Man RA, Honkoop P, Roth WK, Schalm SW, Schmidt JM. Dynamics of hepatitis B virus infection in vivo. J Hepatol. 1997. 27:431–436.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr