Clinical outcome and virologic profiles of severe hepatitis B exacerbation due to YMDD mutations.
OBJECTIVE
To study the outcome and the virologic profiles of severe hepatitis exacerbations due to YMDD mutants in lamivudine-treated patients.


METHODS
Eighteen lamivudine-treated patients with severe hepatitis exacerbations due to YMDD mutants were recruited. Laboratory and clinical parameters were monitored. Viral genotypes and YMDD mutations were determined.


RESULTS
None of the 18 patients had YMDD wild-type during exacerbations. Three (17%) and 15 (83%) patients had genotypes B and C, respectively. Elevated bilirubin levels and prolonged prothrombin time were found in 11 (61%) and six patients (33%) respectively. Three patients (17%) had adverse outcome with the development of ascites and/or encephalopathy. One of these patients required liver transplantation and one died. Both patients had evidence of cirrhosis before treatment and hepatitis B e antigen (HBeAg) seroreversion from anti-HBe positivity. The remaining 16 patients (89%) have no evidence of pre-existing cirrhosis. Thirty seven percent of patients had normal alanine aminotransferase levels at the last follow-up. The median HBV DNA level at the last follow-up was significantly lower than the pre-treatment level (P=0.009).


CONCLUSIONS
Though the majority of patients with severe hepatitis exacerbations due to YMDD mutants had uneventful course, early liver transplantation should be considered in patients with pre-existing cirrhosis and HBeAg seroreversion.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, PR, China.
Man-Fung
MF
Yuen
Takanobu
T
Kato
Masashi
M
Mizokami
Annie On-On
AO
Chan
John Chi-Hang
JC
Yuen
He-Jun
HJ
Yuan
Danny Ka-Ho
DK
Wong
Siu-Man
SM
Sum
Irene Oi-Lin
IO
Ng
Sheung-Tat
ST
Fan
Ching-Lung
CL
Lai
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology* / Q000821:virology*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000410:Alanine Transaminase