title: [Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients].
abstract: OBJECTIVE
  Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy.
  
  
  METHODS
  A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months.
  
  
  RESULTS
  After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable.
  
  
  CONCLUSIONS
  Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Ahn
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Chang
authors.forename: Seong Nam
authors.initials: SN
authors.lastname: Oh
authors.forename: Do Won
authors.initials: DW
authors.lastname: Choi
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Baek
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Jeong
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Choi
authors.forename: Kyoung Oh
authors.initials: KO
authors.lastname: Kim
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Nam Young
authors.initials: NY
authors.lastname: Jo
authors.forename: Jong Jae
authors.initials: JJ
authors.lastname: Bak
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
authors.forename: Myung Seok
authors.initials: MS
authors.lastname: Lee
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Chang Hong
authors.initials: CH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects / Q000254:growth & development; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine