title: Medication nonadherence with long-term management of patients with hepatitis B e antigen-negative chronic hepatitis B.
abstract: OBJECTIVE
  Antiviral treatment responses for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) are well-defined by data from registration trials but may differ from patients seen in community settings where medical adherence is usually not as strictly monitored. The goal of this study was to examine the long-term outcomes of HBeAg-negative patients in a community clinical setting.
  
  
  METHODS
  We performed a cohort study of 189 consecutive treatment-naïve patients with CHB who were treated with either entecavir (ETV) 0.5 mg daily (n=107) or adefovir dipivoxil (ADV) 10 mg daily (n=82) from 2002 to 2009 at two community clinics.
  
  
  RESULTS
  All patients were Asians. Both ETV and ADV cohorts had similar median baseline ALT and HBV DNA levels. By year 4, a similar proportion of ETV and ADV patients who remained on monotherapy achieved complete viral suppression (91-96%); however, more patients in the ADV cohort required alternative therapy (27 vs. 5%). No patients in the ETV cohort developed resistance while 18% of the ADV cohort did. Cumulative nonadherence rates were 10 and 12% in ADV and ETV cohorts, respectively.
  
  
  CONCLUSIONS
  Failure to monotherapy in a community clinical setting is due to both antiviral resistance and patient nonadherence. Medication nonadherence is likely to be a more important contributor to treatment failure than antiviral resistance, especially with new anti-HBV agents such as ETV and tenofovir.
authors.affiliation: Pacific Health Foundation, San Jose, CA 95128, USA. nbha202@gmail.com
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.forename: Nghi B
authors.initials: NB
authors.lastname: Ha
authors.forename: Ruel T
authors.initials: RT
authors.lastname: Garcia
authors.forename: Huy N
authors.initials: HN
authors.lastname: Trinh
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Chaung
authors.forename: Huy A
authors.initials: HA
authors.lastname: Nguyen
authors.forename: Khanh K
authors.initials: KK
authors.lastname: Nguyen
authors.forename: Brian S
authors.initials: BS
authors.lastname: Levitt
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D044466:Asian People / Q000706:statistics & numerical data; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data; D024882:Drug Resistance, Viral; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006513:Hepatitis B e Antigens / Q000097:blood / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; D000225:Adenine; C106812:adefovir dipivoxil