Lamivudine treatment for chronic hepatitis B... : Pediatric Infectious Disease Journal (original) (raw)

Lamivudine treatment for chronic hepatitis B infection in children unresponsive to interferon

Pediatric Infectious Disease Journal

22

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3

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224

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228

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March 2003

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| DOI: 10.1097/01.inf.0000055062.64965.2e

Background/aims.

Lamivudine is a potent inhibitor of hepatitis B virus (HBV) replication. This prospective open study reports the results of lamivudine treatment in children with chronic hepatitis B infection who did not respond to previous interferon treatment.

Patients and methods.

Lamivudine, 3 mg/kg/day (maximum, 100 mg/day), was given for 52 weeks to 20 children and adolescents, ages 8.5 to 19 years, with chronic hepatitis B infection who had been treated with interferon 2 to 5 years earlier. We evaluated virologic and biochemical responses, the occurrence of YMDD mutants and adverse effects.

Results.

All children were HBV DNA+, hepatitis B e antigen (HBeAg)+/anti-hepatitis B e antibody− at start of treatment. At the end of 1 year, HBV DNA declined by 95% in all patients, and 8 of 18 (44%) had sustained undetectable HBV DNA by hybridization assay. Median pretreatment alanine aminotransferase (ALT) ×1.5 upper limit of normal decreased to ALT ×0.9 upper limit of normal after 1 year. One child became HBeAg-negative. YMDD mutants were detected in 11 of 17 (65%) children after 1 year of lamivudine treatment. Among children with YMDD mutant variants, 54% maintained normal ALT values and 45% had undetectable HBV DNA by hybridization assay. No adverse effects were observed.

Conclusions.

Children with chronic hepatitis B infection treated with lamivudine after failure of interferon therapy had decreased HBV replication and improved ALT values. However, lamivudine treatment resulted in an exceptionally high rate of lamivudine-resistant mutants and low HBeAg seroconversion rate.

Copyright © 2003 Lippincott Williams & Wilkins, Inc.