P0324 DNA CLEARENCE AS AN EARLY PREDILICTION OF RESPONSE IN CHRONIC HEPATITIS B INFECTION DURING THERAPY
Bildiriler > Özet Bildiri
Yazarlar: Funda ÇETİN, B. Dikici, S. Targan, A. A. G. Kalayci, T. Doganci, Sema AYDOĞDU, R. V. Yagci
Journal of Pediatric Gastroenterology and Nutrition, , , Uluslararası, Özet Bildiri, Wos, cilt 39, ss S180-S180
DOI: 10.1097/00005176-200406001-00448
Özet
Introduction: To evaluate retrospectively predictive value of HBV DNA clearence to select non-responders during interferon (INF) and lamivudine (LAM) combination therapy in children with chronic hepatitis B infection. Methods: Chronic hepatitis B infection was determined by presence of HbsAg, HbeAg and HBV DNA in serum screened at 3 months intervals for at least 1 year, serum alanine transaminase levels more than 1,5 times the upper normal limit and chronic hepatitis with histologic activity index (HAI) more than 6 by liver biopsy. Hundred and thirty-eight children with chronic hepatitis B infection were randomly assigned into two groups. The first group (n:42, 9,4±3,1 years old) received high dose INF (10MU/m2 thrice-weekly, for 6 months) combined with lamivudine (4mg/kg/d, max. 100mg/d). Ninety-two patients (group II, 8,3±3,5 years old) were treated with standart dose INF (5 MU/m2 thrice-weekly for 6 months)+LAM. Lamivudine was continued orally untill 12th month. End of therapy response was defined as ALT normalization, HBV-DNA clearance and Hbe/anti-HBe sero-conversion. Breakthrough infection was determined as re-emergence of HBV-DNA in serum after its clearance. HBV-DNA clearence assased by hybridization technique at 3rd and 6th months of therapy was evaluated in respect to the end of therapy response in all patients and either of the therapy groups. Sensitivity, specifity, positive and negative predictive value of DNA negativisation was determined. Results: Pretreatment ALT levels of group I and II patients were 102,6±76,2U/l and 93,3±56,6U/l, respectively (p:0,55). Mean HAI score was 7,4±2,6 in group I and 7,6±2,6 in group II (p:0,66). Response was achieved in 41,9% (n:18) of patients in group I and 42,1% (n:40) of group II patients (p:1). HBV-DNA clearence was detected in 34 of patients at 3rd month and sensitivity, specifity, positive-negative predictive value (PPV, NPV) in response prediliction was 100%, 52%, 33% and 100%, respectively, in group I patients. In the second group, 63 patients cleared DNA at 3rd month with 56% sensitivity, 41% specifity, 32% PPV and 65% NPV. Conclusion: HBV-DNA clearence at 3rd month has low value in response prediliction for patients receiving standart dose interferon containing regimens. However; it is found highly sensitive to early select non-responders while monitoring patients on high dose interferon containing combinations.