title: Chronic cirrhotic hepatitis B patients with a high incidence of hepatic decompensation after viral breakthrough with lamivudine-resistant mutants and during rescue treatment.
abstract: OBJECTIVE
  To compare the rate of biochemical and hepatic decompensation after viral breakthrough (V-BT) caused by lamivudine (LMV)-resistant HBV mutants and during rescue treatment for patients with liver cirrhosis (LC) and chronic hepatitis B (CHB).
  
  
  METHODS
  We reviewed the medical records of 205 CHB patients who developed V-BT with LMV-resistant HBV mutants (134 in the CHB group, 71 in the LC group).
  
  
  RESULTS
  Sixty-five of the 205 patients had an alanine aminotransferase (ALAT) flare-up (32%) and 21 (10%) had hepatic decompensation. The ALAT flare-up among the CHB and LC groups occurred in 43 (32%) and 22 patients (31%), respectively, and there was no significant difference between the two groups. Hepatic decompensation occurred in 5 (4%) and 16 (23%) patients with CHB and LC, respectively, and these differences were significant (p=0.001). A total of 187 patients were treated by rescue therapy (CHB 121, LC 66) and 13 cases with hepatic decompensation occurred only in LC patients during rescue therapy. Among them, 11 patients had serum ALAT levels two times higher than the upper normal limit (UNL) and the HBV-DNA was more than 10(7) copies/ml at the baseline of rescue therapy. In contrast, the cumulative ALAT normalization and viral response rates were reached significantly earlier in patients with a serum HBV-DNA of < or =10(7) copies/ml compared with those with an HBV-DNA >10(7) copies/ml (p=0.0221 and 0.0002, respectively).
  
  
  CONCLUSIONS
  Earlier rescue therapy for cirrhotic patients with genotypic resistance due to LMV-resistant mutants may improve patient outcome.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Moon Kyung
authors.initials: MK
authors.lastname: Joo
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Kul
authors.initials: YK
authors.lastname: Jung
authors.forename: Sun Jae
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Jong-Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy; D017093:Liver Failure / Q000453:epidemiology; D008297:Male; D008875:Middle Aged
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine