title: [The clinical meaning of the emergence of viral breakthrough during lamivudine treatment in patients with hepatitis B virus related chronic liver disease].
abstract: OBJECTIVE
  Viral breakthrough has been considered a major limitation of lamivudine in the treatment of hepatitis B virus related chronic liver disease. Its clinical meaning has not been thoroughly assessed.
  
  
  METHODS
  64 patients who showed viral breakthrough during lamivudine treatment were retrospectively reviewed. We evaluated the rate of HBeAg seroconversion and hepatic decompensation after viral breakthrough.
  
  
  RESULTS
  After viral breakthrough, serum alanine transaminase (ALT) elevation more than 1.2 x upper limit of normal (ULN) was noticed in 40 patients (62.5%). Acute flare (serum ALT elevation > x 5 ULN, or serum bilirubin >3 mg/dL) occurred in 15 patients (23.4%). During the period of follow up (15.0 +/- 9.7 months; range, 0-31 months) since viral breakthrough, decreased serum HBV-DNA level to below the detection limit and serum ALT normalization was seen in 15 patients (23.4%). HBeAg seroconversion was noticed in 7 (13.7%) of a total of 51 HBeAg positive patients at base line; in 4 (15.4%) of 26 patients with non-hepatic failure (chronic hepatitis or Child-Pugh class A liver cirrhosis) at base line; and in 2 (40.0%) of 5 patients with non-hepatic failure at base line and acute flare after viral breakthrough. During this period, terminal hepatic decompensation (Child-Pugh class C) or death was noticed in 9 (90.0%) of 10 patients who had hepatic decompensation (Child-Pugh class B or C) at baseline and acute flare after viral breakthrough.
  
  
  CONCLUSIONS
  Acute flare after viral breakthrough seemed to continue during HBeAg seroconversion and rarely developed into terminal hepatic decompensation or death in patients with non-hepatic decompensation at baseline. Its incidence is not only high but lethal to most patients with hepatic decompensation at baseline.
authors.affiliation: Department of Internal Medicine, Kosin University College of Medicine, Korea.
authors.forename: Chan Bog
authors.initials: CB
authors.lastname: Park
authors.forename: Hyun Jeung
authors.initials: HJ
authors.lastname: Lim
authors.forename: Byung Cheol
authors.initials: BC
authors.lastname: Yun
authors.forename: Sang Uk
authors.initials: SU
authors.lastname: Lee
authors.forename: Byung Hoon
authors.initials: BH
authors.lastname: Han
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine