Although loss of
hepatitis B e antigen (
HBeAg) from the serum is sought by treatment with
lamivudine, clearance of
hepatitis B surface antigen (
HBsAg) is the eventual goal of any
antiviral therapy. In a single hepatology center in the Metropolitan Tokyo, 486 patients with
chronic hepatitis B were followed up for longer than 3 years after they started treatment with
lamivudine.
HBsAg disappeared from the serum in 17 (3.5%). Age >or=50 years and low
HBsAg levels (hemagglutination titer <or=2(7)) at the start of
lamivudine were significantly more frequent in the patients who did than did not lose
HBsAg from the serum. Except for these two factors, there were no differences between the two groups of patients in the prevalence of
HBeAg and HBV
DNA levels at the baseline, as well as the development of YMDD mutants and breakthrough
hepatitis during
lamivudine treatment. Using multivariate analysis, age >or=50 years at the start of
lamivudine was the only factor predicting the loss of
HBsAg (hazard ratio: 2.96 [95% confidence interval: 1.14-7.68], P = 0.028). By the method of Kaplan-Meier performed on the 486 patients, the loss of
HBsAg was estimated to occur in 3% and 13% of patients, respectively, who had received
lamivudine therapy for 5 and 10 years. These results indicate that loss of
HBsAg occurs in a minority (3.5%) of patients with
chronic hepatitis B who receive
lamivudine therapy and more frequently in those with lower
HBsAg titers and older ages at the start of treatment.