BACKGROUND/AIMS: In lamivudine-resistant patients with chronic hepatitis B (CHB), we compared efficacy, predictive response factors and changes in viral mutants in two antiviral approaches with adefovir. METHODS: A prospective cohort study on therapy with adefovir alone (29 patients) or combined with ongoing lamivudine (23 patients) was performed. RESULTS: A virological response was achieved in 55% of patients treated with adefovir and in 83% of those treated with the combination (p>0.05). This response was directly related to the basal viral load (p<0.0001) and obtained in 10 patients with basal HBV-DNA<17,200 IU/ml using both strategies. In patients with a higher basal viral load, the virological response was more frequent when treated with the combination (p<0.05). Mutation at locus rt181 predicted HBV-DNA persistence during therapy. A virological rebound was observed in 18% of non-responders while on adefovir monotherapy. CONCLUSIONS: To achieve a complete virological response and reduce the risk of adefovir-resistant mutants in lamivudine-resistant patients, rescue therapy is preferable at early evidence of genotypic resistance. However, in subjects with a significant viral load, combination therapy is more effective. The presence of the rt181 mutation is associated with incomplete response.
BACKGROUND/AIMS: In lamivudine-resistant patients with chronic hepatitis B (CHB), we compared efficacy, predictive response factors and changes in viral mutants in two antiviral approaches with adefovir. METHODS: A prospective cohort study on therapy with adefovir alone (29 patients) or combined with ongoing lamivudine (23 patients) was performed. RESULTS: A virological response was achieved in 55% of patients treated with adefovir and in 83% of those treated with the combination (p>0.05). This response was directly related to the basal viral load (p<0.0001) and obtained in 10 patients with basal HBV-DNA<17,200 IU/ml using both strategies. In patients with a higher basal viral load, the virological response was more frequent when treated with the combination (p<0.05). Mutation at locus rt181 predicted HBV-DNA persistence during therapy. A virological rebound was observed in 18% of non-responders while on adefovir monotherapy. CONCLUSIONS: To achieve a complete virological response and reduce the risk of adefovir-resistant mutants in lamivudine-resistant patients, rescue therapy is preferable at early evidence of genotypic resistance. However, in subjects with a significant viral load, combination therapy is more effective. The presence of the rt181 mutation is associated with incomplete response.
Authors: Fabien Zoulim; Jolanta Białkowska-Warzecha; Mircea Mihai Diculescu; Adrian Eugen Goldis; Renate Heyne; Tomasz Mach; Patrick Marcellin; Jörg Petersen; Krzysztof Simon; Soumaya Bendahmane; Isabelle Klauck; Wojciech Wasiak; Harry L A Janssen Journal: Hepatol Int Date: 2016-05-20 Impact factor: 6.047
Authors: Young Kul Jung; Jong Eun Yeon; Kwang Gyun Lee; Eun Seok Jung; Jeong Han Kim; Ji Hoon Kim; Yeon Seok Seo; Hyung Joon Yim; Sun Ho Um; Ho Sang Ryu; Kwan Soo Byun Journal: Korean J Hepatol Date: 2011-12