Durability Of Effectiveness After Cessation Of Lamivudine Treatment In Patients With Chronic Hepatitis B

Background The effective treatment is antiviral therapy for chronic hepatitis B, which is the most common infectious disease in China.The aims of treatment of chronic hepatitis B are to achieve sustained suppression of HBV replication and remission of liver disease.The goal of treatment is to prevent the progression of chronic hepatitis B to long-term complications,such as cirrhosis and hepatocellular carcinoma,that can result in premature death.Several studies reported that patients with maintained viral suppression had lower rates of hepatic decompensation as well as liver-related mortality.Lamivudine is regarded as effective drug of chronic hepatitis B treatment world widely,which is the first oral nucleoside analog that being approved,but it's antiviral effect is not ideal.Mainly there exists low effective rate, high relapse rate after withdrawing of the drugs and long period using of lamivudine may cause the appearance of drug tolerance mutants and cause the decreasing of antiviral effect.So it is necessary to investigate the durability of effectiveness after cessation of lamivudine treatment in chronic hepatitis B patients to improve it's antiviral effect and decrease high relapse rate.Object To previously investigate the durability of effectiveness after cessation of lamivudine treatment in HBeAg-positive and HBeAg-negative chronic hepatitis B(CHB)patients,and the influencing factors as well.Method Seventy-one patients subjecting to lamivudine for no less than 12 months and HBVDNA-negative and HBeAg seroconvertion duration more than 6 months were HBeAg seroconvertion group;Thirty-eight patients subjecting to lamivudine for no less than 18 months and HBVDNA-negative and HBeAg loss duration more than 6 months were HBeAg loss group;Firty-four patients subjecting to lamivudine for no less than 24 months and HBVDNA-negative duration more than 18 months were HBeAg negative CHB..Hepatic biochemical parameters,HBV-DNA testing,and follow-up were determined after 1.2.3.4.6.9.12 months the followimg every 6 months after cessation of lamivudine treatment respectively.The relapse was defined as HBVDNA＞=104 copies/ml,which was the end point of study.The end point studied of no-relapse ones was the end of follow-up.Twenty-four relapors subjecting to lamivudine retreatment were measured YMDD mutation,112 lamivudine monotherapy patients were histology controls.Results The cumulative rates of relapse after 3,6,12,24 and 36 months after cessation of lamivudine treatment were22.7%.27.5%.29.4%.29.4%and37.3%in HBeAg seroconvertion group,28.9%.37.5%.40.4%.40.4%and 40.4%in HBeAg loss group,22.2%.40.0%.48.0%.52.0%and 60.0%in HBeAg negative CHB,respectively.The relapse rate of HBeAg negative CHB was the highest,the following was of the HBeAg loss group,and of the HBeAg seroconvertion group was the lowest one..Of the 6 HBsAg loss patients during lamivudine treatment,one achieved HBsAg seroconvertion.The patients of HBsAg loss and HBsAg seroconvertion were up to 13 and 6,respectively.The YMDD mutation rates were significantly increased when the relapsors after cessation of lamivudine were retreated by lamivudine.Conclusion The durability of effectiveness after cessation of lamivudine treatment was independently associated with the age at the end of treatment.A longer duration of treatment is needed for older patients..The relapse rate of the baseline HBeAg negative patients was higher than positive ones.The durability of effectiveness of HBeAg negative patients was lower than that of the HBeAg positive ones,so these patients should be given prolonging therapy till HBsAg lost.patients subjecting to lamivudine for no less than 24 months and HBVDNA-negative no less than 18 months and the ages no more than 30 could discontinue treatment.A 18-month duration of follow-up is needed to test the hepatic function and HBVDNA.The patients who relapsed should be retreated with the nucleoside analogs which mutation rates are lower.