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Sustained HBs Seroconversion During Lamivudine and Adefovir Combination
Therapy for Lamivudine Failure: A Case Report
French
researchers describe the case of a patient with chronic
hepatitis B who became resistant to lamivudine
(Epivir-HBV) and was treated successfully with adefovir
dipivoxil (Hepsera) in addition to lamivudine.
Lamivudine
resistance was
associated with the selection of a L180M+M204V polymerase mutant.
After
the addition of adefovir dipivoxil, serum HBV DNA levels dropped
by more than 4 log10, which was followed by HBsAg
clearance after 22 months of combination therapy.
Moreover,
anti-HBs antibody titers rose above 1000 mIU/mL after 32 months
of the new treatment regimen.
In
parallel, HBV DNA declined below 100 copies/mL by a quantitative real time PCR assay.
Analysis
of intrahepatic viral DNA showed a significant decline of total
HBV DNA and cccDNA which was accompanied by a decrease of the number
of infected cells expressing viral antigens below the detection
limit of immunostaining.
In
parallel, liver
histology analysis showed an improvement in both the
activity index and fibrosis
score.
This
report suggests that in patients who previously failed lamivudine
therapy, proactive antiviral treatment may lead to a beneficial
virological and clinical effect.
02/14/05
Reference
M Maynard and others. Sustained HBs seroconversion during lamivudine
and adefovir dipivoxil combination therapy for lamivudine failure.
Journal of Hepatology 42(2): 279-281. February 2005.
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