ALT and viral load decline during PEG-IFN alpha-2b treatment for HBeAg-positive chronic hepatitis B

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J Clin Virol. 2008 Mar 21 [Epub ahead of print]

ALT and viral load decline during PEG-IFN alpha-2b treatment for HBeAg-positive

chronic hepatitis B.

Ter Borg MJ, Hansen BE, Bigot G, Haagmans BL, Janssen HL.

Department of Gastroenterology and Hepatology, Erasmus MC, University Medical

Centre Rotterdam, Rotterdam, The Netherlands.

BACKGROUND: Alanine aminotransferase (ALT) is one of the main indicators for

inflammatory activity in chronic hepatitis B. During interferon-based therapy,

approximately 25%-40% of patients exhibit an ALT flare. OBJECTIVES AND STUDY

DESIGN: To analyze the relation between ALT and HBV-DNA during pegylated

interferon alpha-2b (PEG-IFN) treatment and compare different patterns of

on-treatment viral load decline with the occurrence of ALT flares. RESULTS: Of

the 123 patients included in this study 31 (25%) exhibited an ALT flare during

treatment or follow-up. Six out of 8 (75%) host-induced flares, i.e. ALT flares

which were followed by a HBV-DNA decrease associated with a favorable treatment

outcome, occurred in patients with a delayed HBV-DNA decline pattern (delayed

vs. non-delayed decline, p=.022); 5 of these 8 patients exhibited HBeAg loss and

4 even HBsAg loss at the end of follow-up. The prediction of ALT normalization

was possible using on-treatment viral load. Based on the difference from

baseline, the evolution of viral load and ALT level were strongly interrelated

during treatment and follow-up. With a joint model we estimated a correlation

coefficient of 0.38 (p

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