title: Response to adefovir or entecavir in renal allograft recipients with hepatitic flare due to lamivudine-resistant hepatitis B.
abstract: We studied the effects of adefovir or entecavir in six kidney transplant recipients (mean age 45.7 +/- 7.8 yr) who developed hepatitic flare due to lamivudine-resistant hepatitis B virus (HBV) infection, with 18 months of follow-up. All patients had elevated alanine aminotransferase (ALT) levels and HBV DNA >10(5) copies/mL (median 2.15 x 10(8) copies/mL) at baseline. Serum creatinine and creatinine clearance levels were 137.8 +/- 59.7 mumol/L and 62.6 +/- 18.7 mL/min, respectively. Four patients were treated with adefovir and two with entecavir. Median HBV DNA decreased to 1.99 x 10(5) copies/mL (p = 0.028) after six months, 1.5 x 10(4) copies/mL (p = 0.043) after 12 months, and 7.35 x 10(4) copies/mL (p = 0.068) after 18 months of treatment. There was a corresponding improvement in ALT (34.5 +/- 19.1 U/L after 18 months, p = 0.029 compared with baseline). The rate of HBV DNA suppression was variable, and three patients took over six months for the viral load to decrease to <10(5) copies/mL. After 18 months, HBV DNA was <10(5) copies/mL in four patients and <10(2) copies/mL in one patient. Treatment was well-tolerated and renal function remained stable. We conclude that both adefovir and entecavir are effective in the treatment of lamivudine-resistant HBV in renal allograft recipients, and the reduction of HBV DNA to <10(5) copies/mL could be slow.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: Kai Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.forename: Colin S O
authors.initials: CS
authors.lastname: Tang
authors.forename: Susan
authors.initials: S
authors.lastname: Yung
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism; D004279:DNA, Viral / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D024882:Drug Resistance, Viral; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D016030:Kidney Transplantation; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D003404:Creatinine; D000410:Alanine Transaminase; D000225:Adenine