Lamivudine has a high rate of antiviral resistance. Sequential anti-HBV treatment is commonly used for lamivudine resistance. We report 4 cases with rapid re-detection of HBV mutants during the lamivudine re-treatment.
The article will be published on July 21, 2008 of the World Journal of Gastroenterology. In this report, four patients received lamivudine as an initial treatment of HBV. They had 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 in HBV-DNA with rapid re-emergence 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 re-treatment in patients with pre-exposed lamivudine resistance leads to rapid re-emergence of YMDD mutation with significant viral rebound and subsequent hepatic decompensation. Sequential administration of lamivudine with prior history of YMDD mutation should be abandoned.
The result suggests that lamivudine re-treatment in patients with pre-exposed lamivudine resistance leads to rapid re-emergence of YMDD mutation with significant viral rebound and subsequent hepatic decompensation. Sequential administration of lamivudine with prior history of YMDD mutation should be abandoned.
The study highlights that retreatment with lamivudine in patients with severe liver disease should be avoided.