Telbivudine in a patient with HBeAg-negative CHB and high viremia

Abstract

We report the efficacy of telbivudine in a patient with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) who demonstrated high viremia and evidence of liver fibrosis and had no family history of liver disease. The patient was a 21-year-old man. Laboratory studies at the time of diagnosis showed that, in addition to being HBeAg negative, he was positive for hepatitis B surface antigen and negative for antibody to hepatitis B e antigen. His hepatitis B virus (HBV) DNA level was 6.9 × 10⁹ copies/mL and his alanine aminotransferase (ALT) level was 87 IU/L. Liver biopsy showed significant necroinflammation with mild piecemeal necrotic fibrosis. Telbivudine 600 mg QD was started, and the patient underwent monitoring every 24 weeks. The patient's HBV DNA level was reduced to 1.5 × 10³ copies/mL at 24 weeks and to <500 copies/mL at 1 year. Corresponding ALT levels were 45 and 25 IU/L. No adverse events were reported and no virologic/biochemical breakthrough was observed. Regular monitoring of HBV DNA and ALT levels was continued. One year of treatment with telbivudine monotherapy produced undetectable HBV DNA and normalized ALT levels in this young patient with high viremia.

Keywords: Chronic hepatitis B; hepatitis B e antigen; telbivudine; viremia; fibrosis.

International Journal of Hepatology Vol.1(3) 2010 pp.36-38