Outcome of lamivudine-resistant hepatitis B virus is generally benign except in cirrhotics.
OBJECTIVE
We set to determine factors that determine clinical severity after the development of resistance.


METHODS
Thirty-five Asian patients with genotypic lamivudine resistance were analyzed in three groups: 13/35 (37%) were non-cirrhotics with normal pre-treatment ALT (Group IA), 12/35 (34%) were non-cirrhotics with elevated pre-treatment ALT (Group IB), and 10/35 (29%) were cirrhotics (Group II). Patients were followed for a median of 98 wk (range 26-220) after the emergence of genotypic resistance.


RESULTS
Group IA patients tended to retain normal ALT. Group IB patients showed initial improvement of ALT with lamivudine but 9/12 patients (75%) developed abnormal ALT subsequently. On follow-up however, this persisted in only 33%. Group II patients also showed improvement while on treatment, but they deteriorated with the emergence of resistance with 30% death from decompensated liver disease. Pretreatment ALT levels and CPT score (in the cirrhotic group) were predictive of clinical resistance and correlated with peak ALT levels and CPT score.


CONCLUSIONS
The phenotype of lamivudine-resistant HBV correlated with the pretreatment phenotype. The clinical course was generally benign in non-cirrhotics. However, cirrhotics had a high risk of progression and death (30%) with the development of lamivudine resistance.
Dan
Yock-Young
YY
Division of Gastroenterology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore.
Wai
Chun-Tao
CT
Lee
Yin-Mei
YM
Sutedja
Dede-Selamat
DS
Seet
Bee-Leng
BL
Lim
Seng-Gee
SG
D000328:Adult; D000368:Aged; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine