Outcome of lamivudine-resistant hepatitis B virus is generally benign except in cirrhotics
Dan, Y.-Y. Wai, C.-T. Lee, Y.-M. Sutedja, D.S. Seet, B.-L. Lim, S.-G.
Sutedja, D.S.
Seet, B.-L.
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Alternative Title
Abstract
Aim: We set to determine factors that determine clinical severity after the development of resistance. Methods: Thirty-five Asian patients with genotypic lamivudine resistance were analyzed in three groups: 13/35 (37%) were non-cirrhotics with normal pre-treatment ALT (Group IA), 12/35 (34%) were non-cirrhotics with elevated pre-treatment ALT (Group IB), and 10/35 (29%) were cirrhotics (Group II). Patients were followed for a median of 98 wk (range 26-220) after the emergence of genotypic resistance. Results: Group IA patients tended to retain normal ALT. Group IB patients showed initial improvement of ALT with lamivudine but 9/12 patients (75%) developed abnormal ALT subsequently. On follow-up however, this persisted in only 33%. Group II patients also showed improvement while on treatment, but they deteriorated with the emergence of resistance with 30% death from decompensated liver disease. Pretreatment ALT levels and CPT score (in the cirrhotic group) were predictive of clinical resistance and correlated with peak ALT levels and CPT score. Conclusion: The phenotype of lamivudine-resistant HBV correlated with the pretreatment phenotype. The clinical course was generally benign in non-cirrhotics. However, cirrhotics had a high risk of progression and death (30%) with the development of lamivudine resistance. © 2005 The WJG Press and Elsevier Inc. All rights reserved.
Keywords
Hepatitis B treatment, Lamivudine resistance, Nucleoside analog, YMDD mutants
Source Title
World Journal of Gastroenterology
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Series/Report No.
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Date
2005-07-28
DOI
Type
Article