title: Adefovir dipivoxil is effective for the treatment of cirrhotic patients with lamivudine failure.
abstract: 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.
authors.affiliation: INSERM, U871, Lyon, France. fabien.zoulim@inserm.fr
authors.forename: Fabien
authors.initials: F
authors.lastname: Zoulim
authors.forename: Parviz
authors.initials: P
authors.lastname: Parvaz
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
authors.forename: Yves
authors.initials: Y
authors.lastname: Benhamou
authors.forename: François
authors.initials: F
authors.lastname: Bailly
authors.forename: Marianne
authors.initials: M
authors.lastname: Maynard
authors.forename: Christian
authors.initials: C
authors.lastname: Trepo
authors.forename: Aldo
authors.initials: A
authors.lastname: Trylesinski
authors.forename: Françoise
authors.initials: F
authors.lastname: Monchecourt
mesh_terms: 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
chemical_list: D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000410:Alanine Transaminase; D000225:Adenine; C106812:adefovir dipivoxil