Durability Of Lamivudine Associated HBe Antigen Seroconversion in Chinese-Canadian Patients with Chronic Hepatitis B Virus Infection

Objective: To asses the durability of HBeAg seroconversion in Chinese-Canadian patients treated with lamivudine, and investigate factors predictive of relapse. Methods: We studied Chinese-Canadian patients with chronic HBV treated with lamivudine monotherapy from 1997 to 2002. Only patients with seroconversion were included, defined as conversion from HBeAg(+) to HBeAb(+) with undetectable HBV DNA, and in the case of pre-core mutants (HBeAg(-) chronic hepatitis B) an undetectable HBV DNA level. Results: 18 patients seroconverted on lamivudine. Three patients had pre-core mutants. 14 (78%) patients had HBV relapse with a detectable HBeAg and/or HBV-DNA after lamivudine discontinuation. Mean time to seroconversion was 7.4 months. Mean duration of lamivudine therapy was 10.9 months. Lamivudine was continued a mean of 3.5 months post-seroconversion. There was no difference in baseline ALT, HBV DNA titer, or duration of lamivudine in patients who relapsed. Ten of the 14 patients with relapse were re-started on lamivudine, with remission in 7 patients. Conclusion: Sustained response in the Chinese-Canadian population is poor at 22%. Given the poor sustained response and difficulty in predicting those at risk of relapse it is likely that a prolonged course of lamivudine greater than the suggested one year duration may be needed.