Adefovir dipivoxil is effective for the treatment of cirrhotic patients with lamivudine failure.
OBJECTIVE
Data on the efficacy of adefovir dipivoxil (ADV) in elderly and cirrhotic patients with lamivudine-resistant (LAM-R) chronic hepatitis B are scarce. This retrospective cohort study evaluated the safety and efficacy of ADV in this specific patient population.


METHODS
Sixty-eight cirrhotic LAM-R patients, of whom 19 (27.9%) were elderly (>or=65 years of age) and nine had severe disease (two post-orthotopic liver transplantation, four pre-orthotopic liver transplantation and three decompensated), with hepatitis B virus (HBV) infection received ADV. Virological and biochemical responses to the addition of ADV were analysed.


RESULTS
At inclusion, all patients were receiving LAM; ADV was added. 75.4% of patients received a combination of LAM and ADV throughout this study for a median treatment duration of 12.6 months; the remainder received ADV with an overlap with LAM treatment for a median duration of 7.9 months. At the end of follow-up, 41.2% of patients had undetectable HBV DNA (<or=2000 copies/ml) with a median reduction of 3.4 log(10) copies/ml. Time to reach undetectable HBV DNA was dependent on baseline alanine aminotransferase (ALT) levels and HBeAg status. Normalization of serum ALT levels was observed in 55.2% (32/58) of patients. In patients who were HBeAg positive at baseline, HBeAg loss and seroconversion occurred in 23% (9/39) and 10% (4/39) respectively. No resistance mutations and no significant side effects were observed during the study period.


CONCLUSIONS
Adefovir dipivoxil provides effective and safe treatment in cirrhotic and elderly patients who failed LAM therapy.
Zoulim
Fabien
F
INSERM, U871, Lyon, France. fabien.zoulim@inserm.fr
Parvaz
Parviz
P
Marcellin
Patrick
P
Zarski
Jean-Pierre
JP
Beaugrand
Michel
M
Benhamou
Yves
Y
Bailly
François
F
Maynard
Marianne
M
Trepo
Christian
C
Trylesinski
Aldo
A
Monchecourt
Françoise
F
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D015331:Cohort Studies; D004351:Drug Resistance / Q000502:physiology; D005260:Female; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000378:metabolism; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D019259:Lamivudine; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D012189:Retrospective Studies
D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000410:Alanine Transaminase; D000225:Adenine; C106812:adefovir dipivoxil