Association between ALT and HBV DNA Viral Load in Chronic Hepatitis B Patients Treated with Pegylated Interferon

Association between ALT and HBV DNA Viral Load in Chronic Hepatitis B Patients Treated with Pegylated Interferonaminotransferase (ALT) is a key indicator of liver inflammation in individuals with chronic hepatitis B virus (HBV) infection. During interferon-based therapy, approximately 25%-40% of patients experience ALT "flares" (sudden increases), but the relationship between ALT level and treatment outcome is not well understood.

As reported in the June 2008 Journal of Clinical Virology, researchers from Erasmus Medical Center in the Netherlands conducted a study to analyze the association between ALT and HBV DNA levels during treatment with pegylated interferon alpha-2b (PegIntron), and to assess the relationship between different patterns of viral load decline and ALT flares. [Note: though this study used PegIntron, only the Pegasys brand (pegylated interferon alpha-2a) is approved in the U.S. for treatment of chronic hepatitis B].

Results:

• Of the 123 patients included in the study, 31 (25%) exhibited ALT flares during treatment or follow-up.

• 6 out of 8 (75%) ALT flares which were followed by a decrease in HBV viral load associated with a favorable treatment outcome occurred in patients with a delayed HBV DNA decline pattern (P = 0.022 for delayed vs. non-delayed decline).

• 5 of these 8 patients exhibited hepatitis B "e" antigen (HBeAg) loss and 4 experienced hepatitis B surface antigen (HBsAg) loss at the end of follow-up.

• Prediction of ALT normalization was possible using HBV viral load while on treatment.

• Based on the difference from baseline, the evolution of HBV viral load and ALT level were strongly interrelated during treatment and follow-up.

• With a joint model, the researchers estimated a correlation coefficient of 0.38 (P < 0.001) during the first 4 weeks of the treatment and 0.72 (P < 0.0001) thereafter.