Switching patients with lamivudine resistant chronic hepatitis B virus from tenofovir to adefovir results in less potent HBV-DNA suppression

W F Leemans, H L A Janssen, H G M Niesters, R A de Man

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    Abstract

    The nucleotide analogues, tenofovir disoproxil fumarate and adefovir dipivoxil, inhibit viral replication and are both effective against the hepatitis B virus (HBV). In our department, tenofovir was prescribed in addition to lamivudine for the treatment of lamivudine resistant chronic hepatitis B. After registration of adefovir, 10 patients were switched to adefovir monotherapy. We studied changes in HBV-DNA and alanine aminotransferase (ALT) in these patients. The median treatment duration with tenofovir was 78 weeks resulting in a median viral load reduction of 5.4 (range 6.8-2.3) log(10) copies/mL compared to baseline (P = 0.005). Two patients had an increase >1 log(10) copies/mL during tenofovir treatment. After the switch to adefovir, six out of 10 patients had an HBV-DNA >4 log(10) copies/mL and the median HBV-DNA increased from 2.8 to 4.5 log(10) copies/mL (P = 0.017). The factors associated with relapse were HBV-DNA PCR positivity at the time of switch and genotype B or D. ALT levels at the beginning of tenofovir treatment also might be a factor. Retreatment with tenofovir (n = 3) resulted in a rapid decline in HBV-DNA. Tenofovir is a potent antiviral drug. Switching to adefovir resulted in viral relapse in 60% of patients and retreatment with tenofovir resulted again in viral decline, which suggests that tenofovir is a more potent antiviral agent.

    Original languageEnglish
    Pages (from-to)108-14
    Number of pages7
    JournalJournal of viral hepatitis
    Volume15
    Issue number2
    DOIs
    Publication statusPublished - Feb-2008

    Keywords

    • Adenine
    • Adolescent
    • Adult
    • Antiviral Agents
    • Cohort Studies
    • DNA, Viral
    • Drug Resistance, Viral
    • Female
    • Genotype
    • Hepatitis B virus
    • Hepatitis B, Chronic
    • Humans
    • Lamivudine
    • Male
    • Middle Aged
    • Organophosphonates
    • Retrospective Studies
    • Viral Load
    • Virus Replication

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