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Durability of the virological response after lamivudine discontinuation in lamivudine-resistant patients with a complete virological response after lamivudine and adefovir combination therapy

Authors
 Mi Na Kim  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Do Young Kim  ;  Kwang-Hyub Han 
Citation
 Journal of Medical Virology, Vol.89(1) : 85-90, 2017 
Journal Title
 Journal of Medical Virology 
ISSN
 0146-6615 
Issue Date
2017
MeSH
Adenine/administration & dosage ; Adenine/analogs & derivatives* ; Adult ; Aged ; Anti-HIV Agents ; DNA, Viral/blood ; Drug Therapy, Combination ; Female ; Hepatitis B virus/isolation & purification* ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B, Chronic/virology ; Humans ; Lamivudine/administration & dosage* ; Male ; Middle Aged ; Organophosphonates/administration & dosage* ; Recurrence ; Sustained Virologic Response* ; Time Factors ; Withholding Treatment*
Keywords
antiviral agents ; hepatitis B virus ; resistance
Abstract
We investigated the durability of virological response after lamivudine (LAM) discontinuation in LAM-resistant chronic hepatitis B (CHB) patients with complete virological response after LAM-adefovir (ADV) combination therapy. We enrolled 58 patients switched to ADV monotherapy with undetectable viral loads (<12 IU/ml) and normal alanine aminotransferase levels after ADV add-on combination treatment for at least 6 months in LAM-resistant CHB patients. Virologic relapse was defined as HBV DNA detection at more than 20 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements. During median 40.9 months of follow-up (range 11.5-79.0 months), seven (12.1%) patients experienced virological relapse. The cumulative rate of virological relapse at 3 and 5 years was 5.5% and 22.4%, respectively. Two patients had elevated alanine aminotransferase during virological relapse. These seven patients with virological relapse had undetectable HBV DNA after switching to tenofovir therapy. In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 87.9% of the patients during median 40.9 months follow-up. This adapting step-down strategy, switching from combination therapy to monotherapy in virologically suppressed CHB patients with stable liver disease, may reduce the cost burden and the risk of potentially harmful effects of combination therapy. J. Med. Virol. 89:85-90, 2017. © 2016 Wiley Periodicals, Inc.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/jmv.24616/abstract
DOI
10.1002/jmv.24616
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154089
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