Sustained response after a 2-year course of lamivudine treatment of hepatitis B e antigen-negative chronic hepatitis B

被引:125
作者
Fung, SK
Wong, F
Hussain, M
Lok, ASF
机构
[1] Univ Michigan, Med Ctr, Div Gastroenterol, Ann Arbor, MI 48109 USA
[2] Univ Toronto, Dept Med, Toronto, ON, Canada
关键词
HBV core promoter mutation; HBV precore mutation; hepatitis B virus genotypes; lamivudine resistance;
D O I
10.1111/j.1365-2893.2004.00556.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Lamivudine has demonstrated efficacy for the treatment of hepatitis B e antigen-negative chronic hepatitis B (e-CHB). However, treatment withdrawal after 1 year has been associated with a high rate of relapse while long-term treatment is associated with increasing risks of drug resistance. We report our treatment experience of 50 Chinese-Canadian patients with e-CHB. All patients received lamivudine for 2 years. Treatment was withdrawn at month 24 in patients who had undetectable hepatitis B virus (HBV) DNA by PCR and normal aminotransferases during the second year of therapy. All patients had HBV genotype B or C. Biochemical response at months 6, 12 and 24 was 74%, 71% and 66%, respectively. HBV DNA was undetectable at months 6, 12 and 24 by hybrid capture and PCR assays in 100%, 92% and 86%; and 94%, 88% and 74% patients, respectively. The cumulative rates of genotypic resistance (GR) after 1 and 2 years were 15% and 25%, respectively. Four (44%) patients with GR experienced a hepatitis flare. The probability of clinical and virological relapse 6, 12, and 18 months after treatment withdrawal were 12% and 30%, 18% and 50%, and 30% and 50%, respectively. Reinstitution of lamivudine resulted in prompt virological and biochemical responses. Our study demonstrates that a sustained response can be achieved after a 2-year course of lamivudine in a subset of patients with e-CHB.
引用
收藏
页码:432 / 438
页数:7
相关论文
共 29 条
[1]   An algorithm for the grading of activity in chronic hepatitis C [J].
Bedossa, P ;
Poynard, T .
HEPATOLOGY, 1996, 24 (02) :289-293
[2]   NATURAL COURSE AND RESPONSE TO INTERFERON OF CHRONIC HEPATITIS-B ACCOMPANIED BY ANTIBODY TO HEPATITIS-B-E ANTIGEN [J].
BRUNETTO, MR ;
OLIVERI, F ;
ROCCA, G ;
CRISCUOLO, D ;
CHIABERGE, E ;
CAPALBO, M ;
DAVID, E ;
VERME, G ;
BONINO, F .
HEPATOLOGY, 1989, 10 (02) :198-202
[3]   Two years of lamivudine therapy in anti-HBe-positive patients with chronic hepatitis B [J].
Buti, M ;
Cotrina, M ;
Jardi, R ;
de Castro, EC ;
Rodriguez-Frias, F ;
Sánchez-Avila, F ;
Esteban, R ;
Guardia, J .
JOURNAL OF VIRAL HEPATITIS, 2001, 8 (04) :270-275
[4]  
CARMAN WF, 1989, LANCET, V2, P588
[5]   Hepatitis B e antigen-negative chronic hepatitis B in Hong Kong [J].
Chan, HLY ;
Leung, NWY ;
Hussain, M ;
Wong, ML ;
Lok, ASF .
HEPATOLOGY, 2000, 31 (03) :763-768
[6]   Hepatitis B virus genotype B is associated with earlier HBeAg seroconversion compared with hepatitis B virus genotype C [J].
Chu, CJ ;
Hussain, M ;
Lok, ASF .
GASTROENTEROLOGY, 2002, 122 (07) :1756-1762
[7]   Precore mutant of hepatitis B virus prevails in acute and chronic infections in an area in which hepatitis B is endemic [J].
Chu, CM ;
Yeh, CT ;
Chiu, CT ;
Sheen, IS ;
Liaw, YF .
JOURNAL OF CLINICAL MICROBIOLOGY, 1996, 34 (07) :1815-1818
[8]   Lamivudine as initial treatment for chronic hepatitis B in the United States [J].
Dienstag, JL ;
Schiff, ER ;
Wright, TL ;
Perrillo, RP ;
Hann, HWL ;
Goodman, Z ;
Crowther, L ;
Condreay, LD ;
Woessner, M ;
Rubin, M ;
Brown, NA .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (17) :1256-1263
[9]   World-wide epidemiology of HBeAg-negative chronic hepatitis B and associated precore and core promoter variants [J].
Funk, ML ;
Rosenberg, DM ;
Lok, ASF .
JOURNAL OF VIRAL HEPATITIS, 2002, 9 (01) :52-61
[10]   Rapid detection of genotypes and mutations in the pre-core promoter and the pre-core region of hepatitis B virus genome:: correlation with viral persistence and disease severity [J].
Grandjacques, C ;
Pradat, P ;
Stuyver, L ;
Chevallier, M ;
Chevallier, P ;
Pichoud, C ;
Maisonnas, M ;
Trépo, C ;
Zoulim, F .
JOURNAL OF HEPATOLOGY, 2000, 33 (03) :430-439