A low viral load predicts a higher initial virologic response to adefovir in patients with Lamivudine-resistant chronic hepatitis B.
OBJECTIVE
Adefovir (ADV) is the preferred drug for treating lamivudine (LAM)-resistant hepatitis B. However, not all patients who face virologic breakthrough during LAM treatment respond to ADV. The aim of this study was to determine the factors associated with efficacy of ADV in LAM-resistant hepatitis B patients.


METHODS
The medical records of 231 patients who received ADV due to LAM-resistance were reviewed. Efficacy was assessed by the initial virologic response (IVR), defined as hepatitis B virus (HBV) DNA not being undetectable by real-time PCR at 6 months of ADV treatment.


RESULTS
Seventy patients (30%) achieved IVR. While 'add-on' modality, hepatitis B e antigen (HBeAg) negativity, and low baseline HBV DNA levels were associated with IVR in univariate analysis, multivariate analysis revealed HBeAg status and the DNA level to be the significant factors. The probability of IVR achievement increased sharply per each log(10) copies/mL decrement in the baseline viral load, which was 133 times in patients who had HBV DNA <10(5) copies/mL compared with those who had ≥10(8) copies/mL.


CONCLUSIONS
Factors associated with the IVR were HBeAg negativity and a low baseline viral load. Therefore, when virologic breakthrough with genotypic resistance emerges during LAM therapy, ADV treatment should be considered immediately before further increases in viral load. Additional long-term follow-up data are warranted.
Department of Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Su Rin
SR
Shin
Kwang Cheol
KC
Koh
Geum-Youn
GY
Gwak
Moon Seok
MS
Choi
Joon Hyoek
JH
Lee
Seung Woon
SW
Paik
Byung Chul
BC
Yoo
Aliment Pharmacol Ther. 2007 Apr 15;25(8):891-8
17402992
Hepatology. 2007 Jul;46(1):254-65
17596850
Hepatology. 2001 Oct;34(4 Pt 1):785-91
11584376
N Engl J Med. 2004 Oct 7;351(15):1521-31
15470215
Hepatology. 2000 Nov;32(5):1078-88
11050059
J Hepatol. 2005 Jul;43(1):72-7
15896869
J Viral Hepat. 2009 Feb;16(2):113-20
19175883
Hepatol Int. 2008 Sep;2(3):263-83
19669255
J Hepatol. 2009 Apr;50(4):674-83
19231002
Gastroenterology. 2007 Nov;133(5):1445-51
17983801
Korean J Hepatol. 2008 Dec;14(4):503-12
19119245
Gastroenterology. 2006 Dec;131(6):1743-51
17087951
Hepatology. 2009 Sep;50(3):661-2
19714720
J Hepatol. 2003 Jan;38(1):98-103
12480566
Antivir Ther. 2006;11(6):771-8
17310821
Hepatology. 2008 Sep;48(3):750-8
18752330
Taehan Kan Hakhoe Chi. 2002 Jun;8(2):149-56
12499800
Clin Ther. 2008 Feb;30(2):317-23
18343270
Hepatology. 2007 Feb;45(2):307-13
17256746
J Hepatol. 2006 Feb;44(2):283-90
16338024
Lancet. 2009 Feb 14;373(9663):582-92
19217993
J Med Virol. 2001 Dec;65(4):659-63
11745928
Antivir Ther. 2010;15(2):235-41
20386079
Antivir Ther. 2006;11(6):779-86
17310822
J Gastroenterol. 2009;44(6):601-7
19387534
J Hepatol. 2003 Dec;39(6):1063-9
14642627
J Hepatol. 2005 Dec;43(6):937-43
16168522
Ann Intern Med. 2007 Dec 4;147(11):745-54
17909201
Gastroenterology. 2009 Feb;136(2):486-95
19027013
J Hepatol. 2009 Feb;50(2):227-42
19054588
J Gastroenterol Hepatol. 2005 Jun;20(6):844-9
15946130
J Hepatol. 2009 Jul;51(1):11-20
19345439