Impact of Lamivudine plus Adefovir therapy in chronic hepatitis B Iranian patients, resistant to Lamivudine treatment alone, on disease inhibition: A pilot study

Abstract

AIM: To evaluate the impact of combination therapy with Lamivudine and Adefovir for treatment of chronic hepatitis B in Lamivudine-resistant patients. METHODS: Among the 110 adult chronic hepatitis B Iranian patients whom were treated with Lamivudine, for 36 months, nineteen patients (17%) with no any biochemical and viral responses to Lamivudine alone, were selected and enrolled in the study. Due to resistancy, Adefovir was added to Lamivudine, and continued for 30 months. We measured HBV_DNA viral load and serum AST, ALT in 0, 12, 24, 30 and 0, 6, 12, 18, 24, 30 months, respectively. RESULTS: Between biochemical and viral characteristics, Repeated Measure analysis identified just biochemical markers— Aspartate Aminotransferase level (AST) (P = 0.002) and Alanine Aminotransferase level (ALT) (P = 0.007) —as predictors of response to treatment, while, viral marker—HBV DNA load—was not statistically significant (P = 0.128). CONCLUSIONS: Treatment for a long time, such as 21.5 ± 8.8 months, with Lami- vudine and Adefovir, can cause liver enzymes including AST and ALT, decreasing and being normal. But, this finding is not indicative, for HBV-DNA viral load.

Share and Cite:

Estakhri, A. , Mohamadkhani, A. , Poustchi, H. and Montazeri, G. (2012) Impact of Lamivudine plus Adefovir therapy in chronic hepatitis B Iranian patients, resistant to Lamivudine treatment alone, on disease inhibition: A pilot study. Open Journal of Gastroenterology, 2, 72-75. doi: 10.4236/ojgas.2012.22015.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Kao, J.H. and Chen, D.S. (2002) Global control of hepatitis B virus infection. The Lancet Infectious Diseases, 2, 395-403. doi:10.1016/S1473-3099(02)00315-8
[2] Lok, A.S., Lai, C.L., Leung, N. and Yao, G.B. (2003) Long term safety of Lamivudine treatment in patients with chronic hepatitis B. Gastroenterology, 125, 1714- 1722. doi:10.1053/j.gastro.2003.09.033
[3] Tziomalos. K. (2009) Combination treatment in HBe-Ag negative chronic hepatitis B. World Journal of Hepatology, 1, 43-47. doi:10.4254/wjh.v1.i1.43
[4] Peters, M.G., Hann, H.H., Martin, P. and Heathcote, E.J. (2004) Adefovir dipivoxil alone or in combination with Lamivudine in patients with Lamivudine-resistant chronic hepatitis B. Gastroenterology, 126, 91-101. doi:10.1053/j.gastro.2003.10.051
[5] Hadziyannis, S.J., Tassopoulos, N.C., Heathcote, E.J. and Chang, T.T. (2003) Adefovir dipivoxil for the treatment of hepatitis B e antigen-negative chronic hepatitis B. The New England Journal of Medicine, 348, 800-807. doi:10.1056/NEJMoa021812
[6] Perrillo, R., Hann, H.W., Mutimer, D. and Willems, B. (2004) Adefovir dipivoxil added to ongoing Lamivudine in chronic hepatitis B with YMDD mutant hepatitis B vi- rus. Gastroenterology, 126, 81-90. doi:10.1053/j.gastro.2003.10.050
[7] Lui, C.J., Kao, J.H., Chen, P.J. and Chen, T.C. (2006) Overlap Lamivudine treatment in patients with chronic hepatitis B receiving Adefovir for Lamivudine-resistant viral mutants. Journal of Viral Hepatitis, 13, 387-395. doi:10.1111/j.1365-2893.2005.00704.x
[8] Akyildiz, M., Gunsar, F., Ersoz, G. and Karasu, Z. (2007) Adefovir dipivoxil alone or in combination with Lamivudine resistant compensated chronic hepatitis B. Digestive Diseases and Sciences, 52, 3444-3447. doi:10.1007/s10620-006-9718-8
[9] Rapti, I., Dimou, E., Mitsoula, P. and Hadziyannis, S.J. ( 2007) Adding-on versus switching-to adefovir therapy in Lamivudine-resistant HBeAg-negative chronic hepatitis B. Hepatology, 45, 307-313. doi:10.1002/hep.21534
[10] Hosaka, T., Suzuk, F., Suzuki, Y. and Saithoh, S. (2004) Adefovir dipivoxil for treatment of breakthrough hepatitis caused by Lamivudine-resistant mutants of hepatitis B virus. Intervirology, 47, 362-369. doi:10.1159/000080881
[11] Buti, M., Elefsitionis, I., Jardi, R. and Vargas, V. (2007) Viral genotype and baseline load predict the response to Adefovir treatment in Lamivudine-resistant chronic heaptitis B patients. Journal of Hepatology, 47, 366-372. doi:10.1016/j.jhep.2007.04.011
[12] Lampertico, P., Vigano, M., Manenti, E. and Lavarone, M. (2007) Low resistance to Adefovir combined with Lamivudine: A 3-year study of 145 Lamivudine-resistant hepatitis B patients. Gastroenterology, 133, 1445-1451. doi:10.1053/j.gastro.2007.08.079
[13] Bommel, F.V., Wunsche, T., Mauss, S. and Reinke, P. (2004) Comparison of adefovir and tenofovir in the treat- ment of Lamivudine-resistant hepatitis B virus infection. Hepatology, 40, 1421-1425. doi:10.1002/hep.20464
[14] Bommel, F.V., Zollner, B., Sarrazin, C. and Spengler, U. (2006) Tenofovir for patients with Lamivudine-resistant hepatitis B virus (HBV) infection and high HBV DNA level during Adefovir therapy. Hepatology, 44, 318-325. doi:10.1002/hep.21253
[15] Lampertico, P., Vigano, M., Manenti, E. and Lavarone, M. (2005) Adefovir rapidly suppresses hepatitis B in HBe-Ag negative patients developing genotypic resistance to Lamivudine. Hepatology, 42, 1414-1419. doi:10.1002/hep.20939
[16] Westland, C.E., Yang, H., Delaney, W.E. and Wulfsohn, M. (2005) Activity of Adefovir dipivoxil against all patterns of Lamivudine-resistant hepatitis B viruses in patients. Journal of Viral Hepatitis, 12, 67-73.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.