Viral Hepatitis
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2005; 11(28): 4344-4350
Published online Jul 28, 2005. doi: 10.3748/wjg.v11.i28.4344
Outcome of lamivudine-resistant hepatitis B virus is generally benign except in cirrhotics
Yock-Young Dan, Chun-Tao Wai, Yin-Mei Lee, Dede Selamat Sutedja, Bee-Leng Seet, Seng-Gee Lim
Yock-Young Dan, Chun-Tao Wai, Yin-Mei Lee, Dede Selamat Sutedja, Bee-Leng Seet, Seng-Gee Lim, Division of Gastroenterology, National University Hospital, Singapore
Author contributions: All authors contributed equally to the work.
Supported by the National University of Singapore Grant, No. R-182-000-0001-731
Correspondence to: Dr. Seng-Gee Lim, Division of Gastroenterology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore. mdclimsg@nus.edu.sg
Telephone: +65-67724353 Fax: +65-67794112
Received: December 7, 2004
Revised: January 7, 2005
Accepted: January 13, 2005
Published online: July 28, 2005
Abstract

AIM: We set to determine factors that determine clinical severity after the development of resistance.

METHODS: Thirty-five Asian patients with genotypic lamivudine resistance were analyzed in three groups: 13/35 (37%) were non-cirrhotics with normal pre-treatment ALT (Group IA), 12/35 (34%) were non-cirrhotics with elevated pre-treatment ALT (Group IB), and 10/35 (29%) were cirrhotics (Group II). Patients were followed for a median of 98 wk (range 26-220) after the emergence of genotypic resistance.

RESULTS: Group IA patients tended to retain normal ALT. Group IB patients showed initial improvement of ALT with lamivudine but 9/12 patients (75%) developed abnormal ALT subsequently. On follow-up however, this persisted in only 33%. Group II patients also showed improvement while on treatment, but they deteriorated with the emergence of resistance with 30% death from decompensated liver disease. Pretreatment ALT levels and CPT score (in the cirrhotic group) were predictive of clinical resistance and correlated with peak ALT levels and CPT score.

CONCLUSION: The phenotype of lamivudine-resistant HBV correlated with the pretreatment phenotype. The clinical course was generally benign in non-cirrhotics. However, cirrhotics had a high risk of progression and death (30%) with the development of lamivudine resistance.

Keywords: Lamivudine resistance; YMDD mutants; Hepatitis B treatment; Nucleoside analog