Hepatitis
B Virological Breakthrough During Lamivudine Therapy Researchers
at the recent Digestive Disease Week 2006 conference in Los Angeles presented
a retrospective analysis of factors associated with HBV virological breakthrough
during treatment with lamivudine
(Epivir-HBV). The study included 88 Asian American chronic hepatitis B patients,
43% of whom were infected at birth; 39 had HBeAg-positive
and 45 had HBeAg-negative HBV (four
had unknown status). Between
2000 and 2004, subjects received lamivudine for more than one year (median duration
25 months). All had baseline HBV DNA
of at least 3 logs, with a mean of 6.1 logs among HBeAg-positive patients and
6.6 logs among HBeAg-negative patients. All subjects experienced "optimal
response," defined as an HBV DNA decrease of more than 2 logs and/or total
HBV DNA below 4 logs.
Results
 | After
one year, the mean reduction in HBV DNA was 4.1 logs. | | After
two years, the mean reduction in HBV DNA decreased to 2.7 logs due to virological
breakthrough in some patients, defined as a 1 log or greater increase in HBV DNA
following initial suppression. | | Among
patients with baseline HBV DNA of 6 logs or less, virological breakthrough rates
were 2%, 12%, and 41% at Year 1, Year 2, and Year 3, respectively. | | Among
patients with baseline HBV DNA greater than 6 logs, the corresponding rates were
10%, 30%, and 72%. | | In
a regression analysis, baseline viral load was the most important factor associated
with HBV virological breakthrough. | | 17%,
23%, and 28 % of patients experience HBeAg loss at Year 1, Year 2, and Year 3,
respectively. | | 81%
of patients achieved ALT normalization after six months, and 84% did so after
one year. |
|
Conclusion
 The
researchers concluded that patients with baseline HBV viral load greater than
6 logs are more likely to experience virological breakthrough during treatment
with lamivudine. Patients with lower baseline viral loads, however, may benefit
from lamivudine therapy, which is less expensive than more recently approved HBV
antiviral agents. "For chronic hepatitis C
patients with [a] low level of viral replication, and with financial disadvantages,"
they suggested, "lamivudine may still remain an affordable and effective
therapy."
6/09/06 Reference
H
Chae, H Hann. Baseline HBV DNA level > 6 log is the most important factor associated
with viral breakthrough (BT) during lamivudine (LAM) therapy for chronic hepatitis
B (CHB). Abstract T1840. Digestive Disease Week 2006. May 20-25, 2006. Los Angeles,
California. 
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