Korean J Hepatol > Volume 14(2); 2008 > Article
The Korean Journal of Hepatology 2008;14(2): 235-239.
doi: https://doi.org/10.3350/kjhep.2008.14.2.235
The Korean Journal of Adefovir plus Lamivudine combination therapy in Lamivudine-resistant chronic hepatitis B
So Young Kwon
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
In lamivudine-resistant patients with chronic hepatitis B (CHB), we compared efficacy, predictive response factors and changes in viral mutants in two antiviral approaches with adefovir. Methods: A prospective cohort study on therapy with adefovir alone (29 patients) or combined with ongoing lamivudine (23 patients) was performed. Results: A virological response was achieved in 55% of patients treated with adefovir and in 83% of those treated with the combination (p>0.05). This response was directly related to the basal viral load (p<0.0001) and obtained in 10 patients with basal HBV-DNA<17,200 IU/ml using both strategies. In patients with a higher basal viral load, the virological response was more frequent when treated with the combination (p<0.05). Mutation at locus rt181 predicted HBV-DNA persistence during therapy. A virological rebound was observed in 18% of non-responders while on adefovir monotherapy. Conclusions: To achieve a complete virological response and reduce the risk of adefovir-resistant mutants in lamivudine- resistant patients, rescue therapy is preferable at early evidence of genotypic resistance. However, in subjects with a significant viral load, combination therapy is more effective. The presence of the rt181 mutation is associated with incomplete response.
KeyWords: Hepatitis B, Chronic; Lamivudine; Adefovir; Resistance

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