combination anti-HBV regimen using lamivudine and other agents in treatment of resistant chronic hepatitis B

ABSTRACT

Several difficulties remain in formulating treatment for chronic hepatitis B [CHB], 350 million people are chronically infected with HBV, Chronic infection with hepatitis B virus accounts for an enormous burden of disease worldwide, including up to half of all cases of cirrhosis, end stage liver disease, and hepatocellular carcinoma. To maximize the elimination of the viral infection while minimizing or preventing damage to the liver cells and tissues and development of viral resistance to more antivirals. Eighty eight patients of chronic hepatitis B virus infection with resistance to lamivudine treatment as proved by quantitative PCR [more than 200 IU/ ml]. Their age between [20-60] years, [85 males, and 3 females] were selected from the National Hepatology and Tropical Medicine Research Institute and were included in this study. The included patients were two groups, the first group 42 patients, were receiving Lamivudine, plus [Baraclude] Entecavir [tablet 0.5mg / day] treatment at the time of assessment. The second group 46 patients were receiving [Hepsera tablet 10 mg / day] Adefovir dipivoxil plus lamivudine [tablet]. All the patients were subjected to the following thorough history and clinical examination, abdominal ultrasonography and collection of blood samples for routine liver and kidney function investigations and serological assay for HBsAg, HBsAb, HBeAg, HBeAb, HBcAb quantitative HBV DNA [PCR]. Our results revealed significant differences between the two groups of patients of CHBV infection, resistant to Lamivudine drug, the first group were higher in response to a combination between Lamivudine + [Baraclude] Entecavir, than the second group who were receiving Lamivudine + [Hepsera] Adefovir dipivoxil combination therapy. Our study concluded that the clinical benefit is apparent with high percentage after a combination regimen using Lamivudine + Entecavir than a combination regimen using Lamivudine + Adefovir dipivoxil for the treatment of resistant chronic hepatitis B virus who were treated with Lamivudine only before. Optimal management of chronic hepatitis B, that may require long-term and sometimes lifelong treatment to maintain its clinical benefit is challenging. It is important to initiate treatment with a drug that has the least potential for induction of drug resistance as sequential monotherapy which may result in selection of multidrug resistant HBV mutatants