324 IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Volume : 5 | Issue : 3 | March 2016 • ISSN No 2277 - 8179 | IF : 3.508 | IC Value : 69.48 Research Paper Medical Science Dr. Anand Dev Asst. Professor, Teerthanker Mahaveer Medical College and Research Centre Moradabad (U.P) – 244001 Dr. Sanjeet Kumar Pandit Asst. Professor, Teerthanker Mahaveer Medical College and Research Centre Moradabad (U.P) – 244001 Dr. B Kumar Professor, Teerthanker Mahaveer Medical College and Research Centre Moradabad (U.P) – 244001 A Study on the eicacy of Adefovir dipivoxil in the treatment of HBe antigen Positive Chronic Hepatitis B KEYWORDS : ABSTRACT In patients with HBeAg positive Chronic Hepatitis B 48 weeks of 10 mg Adefovir dipiovoxil per day resulted in reduced serum HBV DNA and alanine transaminases levels and increased rates of HBeAg seroconversion. Adefovir treatment lead to virological and serological improvement in patients with chronic hepatitis B. Introduction:- Hepatitis B virus infection is a global health problem and it is estimated by the World Health Organisation (WHO), that ap- proximately one third of the world population has been infected with HBV with serological evidence of past or present infec- tion with HBV. Of the approximately 2 billion people who have been infected world wide, more than 350 million ( 5 -7 % of the world’s population ) sufer from chronic hepatitis B infection. Approximately 15 – 40 % of the patients infected with HBV will develop life threatening liver consequences ( including cirrhosis, liver failure and hepatocellular carcinoma ) resulting in 600,000 to 1.2 million deaths per year due to HBV. India has over 40 million HBV carriers and accounts for 10 – 15 % of the entire pool of HBV carriers of the world. Of the 25 mil- lion infants born every year in India, it is estimated that that over 1 million run the life time risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illness re- lated to HBV infection. here are varying reports of overall rate of HbsAg positivity in India ranging between 2 – 4.7%.( 1 ) Spread of HBV infection in many South Asian countries is attributed to unsafe blood sup- ply, reuse of contaminated syringes, lack of maternal screening to prevent perinatal transmission and delay in introduction of hepatitis B vaccine. ( 2 ) he predominant mode of transmission is horizontal rather than vertical in India. ( 3 ) Various guidelines including the AASLD, EASL and APASL guide- lines have been published for the management of HBV. he ulti- mate goal of management is to prevent progression of the dis- ease to cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma. Adefovir is a potent nucleotide analogue and has a potent an- tiviral efect when given in chronic hepatitis B cases. In a trial by Mercellin P , Chang TT and et al 2003 it was found that daily doses of 10 mg of Adefovir dipivoxil inhibited HBV replication , reducing serum HBV DNA by approximately 4 log copies per milliliter , normalized alanine transferases and induced HBeAg loss and seroconversion in a diverse population. On the basis of above clinical trials , Adefovir dipivoxil will be used in patients of chronic hepatitis B with E antigen positive to evaluate its eicacy after a period of 48 weeks. Material and Methods:- In the present study 20 cases of Chronic Hepatitis B were se- lected from the OPD medical wards of Katihar medical college Katihar Bihar.hey were given 10 mg Adefovir for 48 weeks.he primary end point was suppression of DNA viral load and nor- malization of liver enzymes. INCLUSION CRITERIA- 1-HBs Ag Positive 2-Hepatitis B e Antigen Positive 3- ALT greater than 2 times normal 4-High DNA Viral load ( >20000 IU / ml ) EXCLUSION CRITERIA- 1. Treated previously with interferon or had received antiviral or immunosuppressive medication. 2. Tested positive for antibody to Hepatitis C virus. 3. Chronic liver disease and other viral hepatitis. 4. Alchol or drug abuse within 1 year of study entry. 5. Obstructitve jaundice. EVALUATION- Serial clinical examination, lab investigation in- cluding DNA Viral load,trans aminases( AST,ALT) and serum alkaline phosphatase were evaluated at 3 monthly interval.USG abdomen was done to look for liver size and echotexture,spleen size and portal vein to look for cirrhosis of liver and hepatocelu- lar carcinoma. Discussion:- A total of 400 patients were screened during the study period of whom 40 patients were selected and randomized for Adefovir af- ter fulillinf the inclusion and exclusion criteria. 20 patients were selected for study group and 20 were selected for the control group. Both the treatment groups were compared with respect to demographic and disease characteristics. Overall there were 31 males and 9 females. he two groups were com- pareble with respect to age and sex distribution. All the patients in both groups completed 48 weeks of therapy. he mean serum bilirubin level in the study group at the time of admission was 0.77± 0.25, median ALT was 115, and median serum HBV was 9.88, SD 0.22 log10 copies / ml, where as in the control group the mean serum bilirubin at the time of admission was 0.76 ± 0.24, mean ALT 417.5 ± 236.91 SD and mean serum HBV DNA 8.3 log10. In the study group 4 weeks after admission mean ALT was 67.5, range 32- 236 and mean viral load reduction was -4.42 log10 cop- ies / ml ( 0.35 SE ) where as in the control group median ALT at