Rapid re-emergence of YMDD mutation of hepatitis B virus with hepatic decompression after lamivudine retreatment

So Young Kwon, Won Hyeok Choe, Chang Hong Lee, Jong Eun Yeon, Kwan Soo Byun

    Research output: Contribution to journalArticlepeer-review

    6 Citations (Scopus)

    Abstract

    Lamivudine has a high rate of antiviral resistance. Sequential treatment of anti-hepatitis B virus (HBV) is commonly used for lamivudine resistance. We report 4 cases of patients with rapid redetection of HBV mutants during the lamivudine retreatment. The four patients received lamivudine as an initial treatment of HBV and adefovir and lamivudine as a rescue therapy consecutively. HBV-DNA level, YMDD mutations and adefovir -resistant mutations (RFMP) were tested every 3 mo during the sequential treatment. All the patients showed YMDD mutations during the initial lamivudine therapy. After adefovir therapy for lamivudine resistance, they showed viral breakthrough. Adefovir was switched to lamivudine, however, it did not induce viral suppression at all, rather increased HBV-DNA with rapid reemergence of the YMDD mutations. All the patients had ALT flares, and hepatic decompensation occurred in two patients. After switching to adefovir combined with entecavir or lamivudine for a rescue therapy, the patients had reduction in HBV-DNA and ALT improvement. These cases demonstrated that lamivudine retreatment of patients with preexposed lamivudine resistance leads to rapid reemergence of YMDD mutation with significant viral rebounds and subsequent hepatic decompensation. Sequential administration of lamivudine in patients with a prior history of YMDD mutation should be abandoned.

    Original languageEnglish
    Pages (from-to)4416-4419
    Number of pages4
    JournalWorld journal of gastroenterology
    Volume14
    Issue number27
    DOIs
    Publication statusPublished - 2008 Jul 21

    Keywords

    • Adefovir dipivoxil
    • Hepatitis B
    • Lamivudine
    • Mutations

    ASJC Scopus subject areas

    • Gastroenterology

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