Evalution of antiviral treatments in patients with chronical hepatitis B

Chronic Hepatitis B virus (HBV) infection in one of the most important causes of liver-related morbidity and mortality. Patients with chronic HBV infection, if untreated have increased risk for developing cirrhosis, decompensation and hepatocellular carcinoma. The objectives for current antiviral therapy include suppressing HBV DNA replication until an undetectable level is achieved, to provide biochemical and histopathological improvements and to achieve HBeAg seroconversion in HBeAg-positive patients. In this study patients who were diagnosed to have chronic hepatitis B and initiated antiviral treatment between January 2007 - May 2014 at Karadeniz Technical University Faculty of Medicine Division of Gastroenterology (n:335) were evaluated. Demographic features and responses to antiviral treatment of the patients were investigated using retrospective review of medical records. 227 male (67,8%) and 108 female (32,2%) totally 335 patients were included to our study. The average age of the patients was 40,3 and it was found 40,7 for the male patients and 39,4 for the female patients. HBeAg was negative in 239 patients (71,3%) and HBeAg was found positive in 96 patients (28,7%). Average age of HBeAg negative patients (41.9) was found higher than HBeAg positive patients (31,8). Initial average HBV DNA level was found 4x108 IU/ml (median 1x108 IU/ml) in HBeAg positive patients whereas it was found 3x107 IU/ml (median 9x105 IU/ml) in HBeAg negative patients. 28 patients were initiated on interferon (8,4%), 60 (17,9%) patients lamivudine, 52 (15,5%) patients telbivudine, 91 (27,2%) patients tenofovir, 94 (28,1%) patients entecavir and 10 (3%) patients adefovir therapy for the treatment of chronic hepatitis B infection. No treatment response evaluation was made for interferon and adefovir group. First year response to therapy with lamivudine, telbivudine, tenofovir and entecavir was evaluated. Virologic responses were found as 56,9%, 84,3%, 81% and 80,9% respectively. Biochemical responses were found as 73,2%, 83,3%, 91,4% and 93,3% respectively. No HBeAg seroconversion was found in the group treated with lamivudine and telbivudine. HBeAg seroconversion ratios in the group treated with tenofovir and entecavir were found as 20% and 3,4% respectively. HBsAg seroconversion was not observed. Five-year treatment outcomes obtained from 96 patients of whom 26 (27,1%) received tenofovir, 47 (48,9%) entecavir and 23 (24%) lamivudine as initial therapy. During five-year follow-up, treatment resistance was considered in 20 (87%) patients receiving lamivudine and 4 (8%) patients receiving entecavir and their treatments were changed with tenofovir. Virologic response ratios were found 13%, 100% and 91,7% for lamivudine, tenofovir and entecavir respectively. On-going biochemical response was observed in all patients. HBeAg seroconversion ratios in tenofovir and entecavir groups were found 45,4% and 53,8% respectively. HBsAg seroconversion was found 3,8% and 2,1% in tenofovir and entecavir groups. As a consequence, according to the clinical response ratios entecavir and tenofovir which both are recommended medications at current guidelines were found similar to each other. Telbivudine although is related to high success level, it's usage only in patients with low viral load and lacking of it's five-year data were limitations for evaluation.