— Christine M. Kukka, Project Manager, HBV Advocate
An international study found the antiviral
combination of tenofovir and emtricitabine (Truvada) was most effective
in treating younger adult hepatitis B patients with high viral load
and normal ALT levels.
Doctors historically have not
treated this group because there appeared to be no sign of liver
damage. However, doctors now know that high viral loads may increase
patients’ risk of liver damage and cancer as they age, despite their
normal ALT levels.
Most participants in the study
were Asian and the average age was 33. Nearly all were HBeAg-positive
and had HBV DNA levels at around 10 million IU/mL. Sixty-four patients
were treated with tenofovir (300 mg daily) and 62 were treated with the
combination pill containing tenofovir (300 mg) and emtricitabine (200
mg).
After 192 weeks of treatment,
55% of patients treated with just tenofovir and 76% of patients treated
with the combination Truvada pill had nearly undetectable HBV DNA
levels (less than 69 IU/mL). None of the patients developed drug
resistance.
HBeAg seroconversion (loss of
HBeAg and development of “e” antibodies) occurred in three patients in
the tenofovir group. None of the patients in either group lost HBsAg.
Researchers reported that women
in the study fared better than men from either treatment and that
Truvada was superior to tenofovir alone in lowering viral load.
However, HBeAg seroconversion and HBsAg clearance rates remained low in
both groups, according to their report published in the January 2014
issue of the journal Gastroenterology. (1)
An unrelated study in Spain
also explored the success of long-term antiviral treatment in 33
HBeAg-positive patients (older, with an average age of 42) with high
viral loads. The patients were treated longer, for nearly four years,
37% with lamivudine, 24% with tenofovir and 21% with entecavir.
This group appeared to have
more success, with 19 (57%) achieving HBeAg seroconversion and 27%
clearing HBsAg. No patient regained HBsAg during three years of
follow-up after treatment ended, according to the report published in
the January issue of the journal of Gastroenterology and Hepatology.
However, seven of the patients developed drug resistance to lamivudine and one developed adefovir resistance.
“Treatment with (antivirals)
achieves a high seroconversion rate (57.57%) and a considerable
percentage of HBsAg clearance (27.27%),” researchers concluded. (2)
Labels: high viral load, Truvada (tenofovir and emtricitabine), young adults
