| Theme |
Cutting Edge : Pathogenesis and Treatment of Hepatitis B |
| Title |
Lamivudine, Adefovir Dipivoxil Treatment for Patients with Chronic Hepatitis B |
| Author |
Ichiro Miyajima |
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine |
| Author |
Tatsuya Ide |
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine |
| Author |
Michio Sata |
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine |
| [ Summary ] |
Lamivudine (LVD) is the first nucleoside analog to show efficacy in the treatment of chronic hepatitis B virus (HBV) infection. Suppression of HBV replication obtained with LAM lead to clinical improvement in chronic hepatitis B (CHB) cases with decompensated cirrhosis. During longterm LVD treatment, HBV strains with YMDD mutations appear at a rate that increases over time. After the appearance of YMDD mutations, HBV-DNA levels in the blood increase. Emergence of LVD resistance leads to disease progression. Adefovir dipivoxil (ADV) is also approved for treatment of CHB infection and exhibits activity against LVD-resistant HBV. Therefore, a switch to ADV is usually recommended for patients with LVD-resistant HBV. However, in patients with LVD-resistant HBV, resistance to ADV is increased. ADV-resistance was observed in 20% of LVD-resistant CHB cases where patients received ADV monotherapy but not in patients who received LVD and ADV. Entecavir (ETV) is also approved for treatment of LVD-resistant HBV. However, ETV resistance was found in 10% of LVD-resistant CHB cases after two years of ETV treatment, but not in treatment-naĩve patients. Therefore, LVD plus ADV combination treatment may be a better option for patients with LVD-resistant HBV. |