ABSTRACT
Background: Patients with chronic hepatitis B virus (HBV) who are positive for e antigen (HBeAg) and have a high viral load are considered to be poor therapeutic responders to pegylated interferon (PEG-IFN). The aim of this study was to assess the therapeutic response of sequential therapy, lamivudine (LAM) followed by PEG-IFN, in these cases. Methods: Chronic HBV patients who were HBeAg positive, with HBV DNA over 107 IU/ml and ALT 2-10 times the upper normal limit, and who were treatment naive were included in our study. Those with concurrent hepatitis C or HIV infection, liver cirrhosis or decompensated cirrhosis, or pregnancy were excluded. The enrolled cases received therapy with PEG-IFN monotherapy for 48 weeks (PEG-IFN group) or sequential therapy with lamivudine (LAM) for 4 weeks followed by PEG-IFN therapy for 48 weeks (LAM/ PEG-IFN group). Results: There were 10 patients in each group, and there were no differences in age, gender, HBV genotype, pre-treatment ALT, and HBV DNA levels between the two groups. The biochemical, virological and serologic responses within 24 weeks after treatment were 40%-60%, 30-50%, and 40-50%, respectively, in the PEG-IFN group, compared with 70%, 20-40%, and 20-40%, respectively, in the LAM/PEG-IFN group. The rates of positive EOT were 30% and 10% in the PEG-IFN group and the LAM/PEG-IFN group, respectively, with rates of 40% and 10% in the SVR-12-week subgroup, and 30% and 20%, respectively, in the SVR-24-week subgroup. The therapeutic responses between the two groups showed no differences. Conclusion: In chronic HBV patients who were positive for HBeAg positive and with a high viral load at baseline, similar therapeutic responses were noted between the sequential LAM/PEG-IFN therapy group and the PEG-IFN monotherapy group. Further research with a higher number of patients and a prolonged LAM course are needed to confirm the efficacy of this approach.