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Influence of the Hepatitis B e Antigen/ Anti-HBe Status on the Response to Lamivudine

Objective: The optimal therapeutic regimen of lamivudine for chronic hepatitis B is not agreed upon, especially with reference to hepatitis B e antigen (HBeAg) or the corresponding antibody (anti-HBe) in sera of patients. Methods: We analyzed 249 Japanese patients with chronic HBV infection who were treated with lamivudine for more than 12 months. HBeAg was detected in sera from 117 of them (47%). HBV DNA sequences in serum samples from the pretreatment period and during therapy were amplified by polymerase chain reaction, and analyzed for mutations. Results: Lamivudine normalized serum levels of alanine aminotransferase at 6 and 12 months, and suppressed serum HBV DNA to levels undetectable by the bDNA method in most patients. Lamivudine suppressed HBV DNA levels to a greater extent in patients with anti-HBe than HBeAg. In patients treated with lamivudine for 5 years, HBV mutants with mutations in the precore region and core promoter reverted to the wild-type in some of them within 1 year. Conclusion: Lamivudine induces a better response in patients without than in those with HBeAg. It initially selects the wild-type HBV from among precore or core promoter mutants.