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Chapter 2.5
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hepatocellular carcinoma. 30-32 Furthermore, this HBV DNA threshold and the duration of
follow-up correspond with the defi nition of response to peginterferon therapy according
to the recent European guidelines and the pivotal studies on peginterferon in chronic
hepatitis B, respectively. 10, 20, 33
The large majority of our patients were of Caucasian origin and infected with HBV
genotypes A and D. Responsiveness to interferon-based therapy appears to be lower
in genotype D compared to other genotypes, which may explain the limited effi cacy of
peginterferon in our study population. 9-10, 26, 34 A recent retrospective analysis of 264
HBeAg-negative patients treated with peginterferon alfa-2a alone or in combination
with lamivudine reported that pretreatment HBsAg levels varied according to genotype.
The highest concentrations were found in patients infected with genotypes A and D.
Although serum HBsAg levels decreased during the treatment phase in all genotypes,
HBsAg decline was least pronounced in genotype D. 35 Therefore, our data on HBsAg
decline need to be confi rmed in genotypes B and C.
In summary, the current study shows that a combination of early quantitative serum
HBsAg and HBV DNA levels allows the best selection of patients with HBeAg-negative
CHB who will not respond to a 48-week course of peginterferon alfa-2a therapy. Discontinuation
of peginterferon therapy and a switch to alternative treatment appears to
be indicated in patients without a decline in HBsAg level combined with less than 2 log
copies/mL decline in HBV DNA level at week 12.