[A study on the treatment of chronic hepatitis B with YMDD mutation].
OBJECTIVE
To explore the strategy for the treatment of chronic hepatitis B with YMDD mutation.


METHODS
A total of 120 chronic hepatitis B patients with YMDD mutation were randomly assigned into four groups. In group A, patients received adefovir dipivoxil for 48 weeks. In group B, patients received adefovir dipivoxil in combination with lamivudine during the first 12 weeks and adefovir dipivoxil only for the following 36 weeks. In group C, patients received adefovir dipivoxil in combination with lamivudine for 48 weeks. In group D, patients received entecavir for 48 weeks.


RESULTS
The rate of rebound of alanine aminotransferase (ALT) was 30.0% (9/30), 10.0% (3/30), 6.7% (2/30), 10.0% (3/30) (P < 0.05) during the first 12 weeks, and one patient with severe hepatitis was found in group A. The positive rate of YMDD mutation was 17.9%, 0, 0, 0 at week 12. There was no significant difference in the level of ALT and the rate of HBeAg seroconversion after 48-week treatment (P > 0.05). At week 48, there was significant difference in the ALT normalization rate and undetectable HBV DNA rate between group C and group A, and also between group D and group A, and the rate of drug resistant genotype was 6.9%, 6.7%, 0, 0. Two patients had rtN236T mutation in group A, and one patient had rtN236T mutation and another one had rtA181V mutation in group B.


CONCLUSIONS
Adefovir dipivoxil in combination with lamivudine or entecavir are safe and effective therapies for chronic hepatitis B patients with YMDD mutation.
Qiu
Yuan-Wang
YW
Wuxi Infectious Disease Hospital, Wuxi 214000, China. qywang839@126.com
Jiang
Xiang-Hu
XH
Huang
Li-Hua
LH
Hu
Tai-Hong
TH
Ding
Hong
H
Jiang
Yue-Ming
YM
Dai
Ya-Xin
YX
Zhou
Min
M