Association between ALT and HBV DNA Viral Load in Chronic Hepatitis B Patients
Treated with Pegylated Interferon
Alanine
aminotransferase (ALT) is a key indicator of liver inflammation in individuals
with chronic hepatitis B virus (HBV) infection.
During interferon-based therapy,
approximately 25%-40% of patients experience ALT "flares" (sudden increases),
but the relationship between ALT level and treatment outcome is not well understood.
As
reported in the June 2008 Journal of Clinical Virology, researchers from
Erasmus Medical Center in the Netherlands conducted a study to analyze the association
between ALT and HBV DNA levels during treatment with pegylated
interferon alpha-2b (PegIntron), and to assess the relationship between different
patterns of viral load decline and ALT flares. [Note: though this study used PegIntron,
only the Pegasys
brand (pegylated interferon alpha-2a) is approved in the U.S. for treatment
of chronic hepatitis B].
Results:
•
Of the 123 patients included in the study, 31 (25%) exhibited ALT flares during
treatment or follow-up.
•
6 out of 8 (75%) ALT flares which were followed by a decrease in HBV viral load
associated with a favorable treatment outcome occurred in patients with a delayed
HBV DNA decline pattern (P = 0.022 for delayed vs. non-delayed decline).
•
5 of these 8 patients exhibited hepatitis B "e"
antigen (HBeAg) loss and 4 experienced hepatitis
B surface antigen (HBsAg) loss at the end of follow-up.
•
Prediction of ALT normalization was possible using HBV viral load while on treatment.
•
Based on the difference from baseline, the evolution of HBV viral load and ALT
level were strongly interrelated during treatment and follow-up.
•
With a joint model, the researchers estimated a correlation coefficient of 0.38
(P < 0.001) during the first 4 weeks of the treatment and 0.72 (P < 0.0001)
thereafter.
"There
was a strong relation between ALT and viral load in HBeAg positive chronic hepatitis
B patients treated with pegylated interferon alpha-2b, especially after 4 weeks
of treatment," the study authors concluded. "Patients with a delayed
decline in viral load often exhibited a host-induced flare associated with a favorable
outcome."
6/17/08
Reference
MJ ter Borg, BE Hansen,
G Bigot, and others. ALT and viral load decline during PEG-IFN alpha-2b treatment
for HBeAg-positive chronic hepatitis B. Journal of Clinical Virology 42(2):
160-164. June 2008. |
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