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- Title
Four years of treatment with lamivudine: clinical and virological evaluations in HBe antigen-negative chronic hepatitis B.
- Authors
Gaia, S.; Marzano, A.; Smedile, A.; Barbon, V.; Abate, M. L.; Olivero, A.; Lagget, M.; Paganin, S.; Fadda, M.; Niro, G.; Rizzetto, M.
- Abstract
: To evaluate the clinical and virological impact of the prolonged use of lamivudine in 94 patients with HBe antigen-negative chronic hepatitis B. : Initial virological and biochemical responses were obtained in 84 (89%) and in 83 (88%) patients respectively. : The virological response peaked within the first 12 months, but diminished to 39% at 48 months because of drug resistance. Overall a virological breakthrough developed in 44 patients (52.4%). After virological breakthrough, the actuarial probability of maintaining biochemical remission diminished to 15% at 24 months and 0% at 29 months. There was no response in 10.6%. Polymerase gene mutations were observed in 82.5% of virological breakthroughs but also in 75% of the non-responders. Overall 7.4% of patients developed a hepatocellular carcinoma. : Almost 90% of patients responded initially to lamivudine but the emergence of drug resistance progressively reduced the rate of virological remission to 39% at the fourth year of therapy. YMDD mutants explained the 75% of lamivudine resistances and were also selected very early in non-responders. Although the biochemical response is invariably lost within 29 months of the YMDD mutant's duration, the clinical outcome was benign despite severe postvirological breakthrough hepatitic flares in about 12% of cases.
- Subjects
VIROLOGY; ANTIGENS; HEPATITIS B; LIVER diseases; THERAPEUTICS
- Publication
Alimentary Pharmacology & Therapeutics, 2004, Vol 20, Issue 3, p281
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/j.1365-2036.2004.02073.x