Comparison of activity of oral antiviral therapies in chronic hepatitis B patients

The goal of therapy for Chronic Hepatitis B is preventing progression of disease to cirrhosis, end-stage liver disease, hepatocellular carcinoma. Although the hepatitis B virus has not directly cytopathic effect, it has been shown that persistence of viral replication is correlated with degree of liver damage. Therefore, the expectation of antiviral therapy is long-term viral suppression. In this study, we investigated medical records of Chronic HBV patients, recieved anti-viral therapy and followed at Gastroenterology Department of Adnan Menderes University Medical Faculty, retrospectively. At the end of investigation we tried to expose effectiveness of antiviral therapy as well as factors affecting treatment. We analyzed 72 patients with chronic hepatitis B infection followed up at our clinic. Of these patients, 35 received Tenofovir, 19 received Lamivudine and 18 received Entekavir. Mean serum HBV DNA level of patients, received Lamivudine, was significantly lower than other groups (p: 0,003). There are no differences between the three groups in terms of other routine laboratory tests, clinical findingsand the ratio of undetectable HBVDNA levels at 3, 6, 9, 12 months. Of the 72 patients, 23 were HBeAg +, 49 were HBeAg -. Mean serum HBV DNA level of HBeAg + patients was significantly higher than HBeAg – patients (p: 0,001). On the side the ratio of undetectable HBVDNA levels of HBeAg - patients were significantly higher than HBeAg + patients at 6, 9, 12 months of therapy (p values 0.001, 0.015, 0.001 respectively). There were no significant differences between HBeAg + and HBeAg – patients on terms of incidence of virological breakthrough. In the light of these findings, there is no superiority between antiviral agents, which were compared in our study, Tenofovir, Lamivudine and Entekavir in clinical practise. It is revealed that the main factor that determine response to therapy is positive or negative state of HBeAg rather than antiviral agent. It is suggested that practitioners should be aware of positive state of HBsAg and personal experience rather than clinical and laboratory findings.