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Sequential
Combined Treatment with Lamivudine and Interferon Alfa in Young
People with Chronic Hepatitis B
So
far there is no effective treatment for HBeAg positive individuals
with a high HBV viral load and low alanine
aminotransferase (ALT) levels. To address this, researchers
evaluated whether priming lamivudine (Epivir-HBV) treatment might
enhance the antiviral and immunostimulant action of lamivudine
in combination with standard
interferon alfa (IFN) in young tolerant patients.
Eleven
chronic HBeAg positive patients
received: 100 mg/day lamivudine for 3 months followed by IFN 5 MU/m2/tiw
with lamivudine 100 mg/day for 6 months and then lamivudine alone
100 mg/day for 9 months.
Quantitative
hepatitis B virus (HBV)-DNA was evaluated during treatment and core-promoter,
precore and polymerase HBV mutants were detected by direct sequencing
at the end of therapy.
Serum
HBV-DNA levels dropped during lamivudine monotherapy
and in combination with IFN.
After
IFN withdrawal, viremia transiently increased to high levels in
five of 11 (45%) patients who showed rt M204V/I lamivudine mutant
resistant.
Two
patients cleared HBeAg without anti-HBe seroconversion. One patient
presented core-promoter and precore stop codon mutations.
Conclusions
Three-phase
sequential combined lamivudine/IFN treatment reduced HBV-DNA serum
level, but did not lead to HBeAg and HBV-DNA clearance in these
highly viremic, normal ALT patients. Lamivudine/IFN combination
did not prevent the emergence of YMDD lamivudine
resistance.
The
authors conclude, “New schedules of antiviral treatments must be
evaluated in this population at risk of disease progression.”
04/01/05
Reference
N
H Park and others. Monitoring of HBeAg levels may help to predict
the outcomes of lamivudine therapy for HBeAg positive chronic hepatitis
B. Journal of Viral Hepatitis 12(2): 216-221. March 2005.
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