Introduction Pegylated Interferon (PEG IFN) is NICE approved for the treatment of chronic hepatitis B (HBV) but it is now known that the response is genotype dependent. To analyse the long term outcome of chronic hepatitis B patients treated with Pegylated Interferon.
Methods Retrospective analysis of our hepatitis B database to identify HBV patients treated with PEG IFN. The following data were obtained from the patient's records and our electronic reporting systems: demographics, length of treatment, ALT and viral load (HBV PCR) at various points during and after treatment.
Results 13 patients (9 males, average age 36.8 yrs; 4 females, average age 34.7 yrs) were treated from April 2007 with a mean follow-up of 33 months (133 weeks). There were 8 eAg +ve and 5 eAg –ve patients. None were co-infected with the Delta virus. In the eAg +ve group, there were 3 genotype D (South Asians), 3 genotype C (2 Chinese and 1 South Asian), 1 genotype B (South Asian) and 1 unknown genotype (white Caucasian). All had a raised ALT and mild changes (Ishak fibrosis score 0–2) on liver biopsy. 4/8 (50%)—3 Genotype C, 1 Genotype D—achieved eAg seroconversion to eAb +ve and 1/8 (13%)—unknown genotype—achieved sAg clearance at the end of treatment. ALT normalised only in those who seroconverted. HBV PCR was <200 IU/ml in 5/8 patients at week 24 and 4/8 patients had undetectable PCR at the end of treatment at week 48 (lack of data for two patients, one failed treatment and one HBV PCR 42 IU/ml). There were three cases of lamivudine resistance. Four patients relapsed within 1-year post PEG IFN (all genotype D) and required treatment with tenofovir (+/− lamivudine). In the eAg –ve group, there were four genotype D patients (all South Asians, two co-infected with HCV genotype 3a) and 1 unknown genotype (Chinese). The three non co-infected patients showed good response at the end of treatment but all relapsed within 1 year and all needed further treatment with nucleoside analogues with good viral response. The co-infected patients achieved sustained viral response for HCV and maintained a low HBV viral load.
Conclusion This study confirms good outcomes for non-genotype D patients treated with PEG IFN. However, eAg –ve patients with genotype D treated with PEG IFN tend to relapse after treatment. The use of HBsAg quantification will help to tailor treatment in the future.
Competing interests None declared.
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