Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients

Soo Hyun Ahn, Yun Jung Chang, Seong Nam Oh, Do Won Choi, Soo Jung Baek, Won Seok Jeong, Chang Won Choi, Kyoung Oh Kim, Hyung Joon Yim, Nam Young Jo, Jong Jae Bak, Jae Seon Kim, Young-Tae Bak, Myung Seok Lee, Jong Eun Yeon, Kwan Soo Byun, Chang Hong Lee

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Abstract

BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

Original languageEnglish
Pages (from-to)389-396
Number of pages8
JournalTaehan Kan Hakhoe chi = The Korean journal of hepatology
Volume8
Issue number4
Publication statusPublished - 2002 Jan 1

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Lamivudine
Chronic Hepatitis B
Hepatitis B virus
Therapeutics
Hepatitis B e Antigens
DNA
Liver Failure
Serum
Bilirubin
Hepatitis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ahn, S. H., Chang, Y. J., Oh, S. N., Choi, D. W., Baek, S. J., Jeong, W. S., ... Lee, C. H. (2002). Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients. Taehan Kan Hakhoe chi = The Korean journal of hepatology, 8(4), 389-396.

Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients. / Ahn, Soo Hyun; Chang, Yun Jung; Oh, Seong Nam; Choi, Do Won; Baek, Soo Jung; Jeong, Won Seok; Choi, Chang Won; Kim, Kyoung Oh; Yim, Hyung Joon; Jo, Nam Young; Bak, Jong Jae; Kim, Jae Seon; Bak, Young-Tae; Lee, Myung Seok; Yeon, Jong Eun; Byun, Kwan Soo; Lee, Chang Hong.

In: Taehan Kan Hakhoe chi = The Korean journal of hepatology, Vol. 8, No. 4, 01.01.2002, p. 389-396.

Research output: Contribution to journalArticle

Ahn, SH, Chang, YJ, Oh, SN, Choi, DW, Baek, SJ, Jeong, WS, Choi, CW, Kim, KO, Yim, HJ, Jo, NY, Bak, JJ, Kim, JS, Bak, Y-T, Lee, MS, Yeon, JE, Byun, KS & Lee, CH 2002, 'Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients', Taehan Kan Hakhoe chi = The Korean journal of hepatology, vol. 8, no. 4, pp. 389-396.
Ahn, Soo Hyun ; Chang, Yun Jung ; Oh, Seong Nam ; Choi, Do Won ; Baek, Soo Jung ; Jeong, Won Seok ; Choi, Chang Won ; Kim, Kyoung Oh ; Yim, Hyung Joon ; Jo, Nam Young ; Bak, Jong Jae ; Kim, Jae Seon ; Bak, Young-Tae ; Lee, Myung Seok ; Yeon, Jong Eun ; Byun, Kwan Soo ; Lee, Chang Hong. / Clinical outcome in cases of viral breakthrough during lamivudine therapy in chronic hepatitis B patients. In: Taehan Kan Hakhoe chi = The Korean journal of hepatology. 2002 ; Vol. 8, No. 4. pp. 389-396.
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abstract = "BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11{\%}) maintained normal ALT levels and 66 patients (89{\%}) showed elevation of ALT. 30 patients (41{\%}) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63{\%}). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.",
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AU - Ahn, Soo Hyun

AU - Chang, Yun Jung

AU - Oh, Seong Nam

AU - Choi, Do Won

AU - Baek, Soo Jung

AU - Jeong, Won Seok

AU - Choi, Chang Won

AU - Kim, Kyoung Oh

AU - Yim, Hyung Joon

AU - Jo, Nam Young

AU - Bak, Jong Jae

AU - Kim, Jae Seon

AU - Bak, Young-Tae

AU - Lee, Myung Seok

AU - Yeon, Jong Eun

AU - Byun, Kwan Soo

AU - Lee, Chang Hong

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N2 - BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

AB - BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

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