Long-term effect of lamivudine treatment on the incidence of hepatocellular carcinoma in patients with hepatitis B virus infection.

BACKGROUND: Nucleotide analogues have recently been approved for the treatment of patients with hepatitis B virus (HBV) infection. However, it is still controversial whether the decrease of HBV-DNA amount induced by treatment with nucleotide analogues can reduce the risk of hepatocellular carcinoma (HCC) development in HBV patients. METHODS: A total of 293 HBV patients without HCC who were treated with lamivudine (LAM) were enrolled in a multicenter trial. The incidence of HCC was examined after the start of LAM therapy, and the risk factors for liver carcinogenesis were analyzed. The mean follow-up period was 67.6 ± 27.4 months. RESULTS: On multivariate analysis for HCC development in all patients, age ≥50 years, platelet count <14.0 × 10(4)/mm(3), cirrhosis, and median HBV-DNA levels of ≥4.0 log copies/ml during LAM treatment were significant risk factors. The cumulative carcinogenesis rate at 5 years was 3% in patients with chronic hepatitis and 30% in those with cirrhosis. For the chronic hepatitis patients, the log-rank test showed the significant risk factors related to HCC development to be age ≥50 years, platelet count <14.0 × 10(4)/mm(3), and hepatitis B e antigen negativity, but median HBV-DNA levels of <4.0 log copies/ml (maintained viral response, MVR) did not significantly suppress the development of HCC. In cirrhosis patients, however, the attainment of MVR during LAM treatment was revealed to reduce the risk of HCC development. CONCLUSIONS: These results suggest that the incidence of HCC in HBV patients with cirrhosis can be reduced in those with an MVR induced by consecutive LAM treatment.

Initial viral response is the most powerful predictor of the emergence of YMDD mutant virus in chronic hepatitis B patients treated with lamivudine.

AIM: Lamivudine (LAM) has been widely used to treat chronic hepatitis B (CHB) patients, but the emergence of a LAM-resistant virus greatly limits its therapeutic efficacy. In this study, we tried to identify factors affecting the emergence of a LAM-resistant virus in CHB patients treated with LAM. METHODS: The subjects were 190 CHB patients in continuous LAM therapy (139 males, mean age 50 years, 87 HBeAg-positive). The mean duration of follow-up was 39 months (range 12-104). The initial viral response (IVR) was defined as HBV DNA < 4.0 logcopies/mL, and the initial biochemical response (IBR) as normalization of alanine aminotransferase (ALT) (<40 IU/L) at 6 months. RESULTS: IVR was positive in 86% of the patients. The cumulative emergence rates of LAM-resistant virus were 10% at 1 year, 30% at 2 years and 46% at 3 years. In univariate analysis, factors contributing to the emergence of LAM-resistant virus were baseline HBV DNA > 6.5 logcopies/mL (P = 0.0044), HBeAg-positivity (P = 0.0062), IBR (P = 0.01) and IVR (P < 0.0001). The cumulative emergence rates of LAM-resistant virus in IVR-positive and -negative patients were 4% and 41% at 1 year, and 41% and 79% at 3 years. In multivariate analysis, only IVR was an independent factor affecting the emergence of LAM-resistant virus (P < 0.0001). CONCLUSION: IVR is a useful factor for predicting the emergence of LAM-resistant virus in CHB patients treated with LAM. For IVR-negative patients, therapeutic options other than LAM monotherapy should be used because of the high incidence of the emergence of LAM-resistant virus.

[Improvement of mental health and the quality of life after catheter ablation for paroxysmal supraventricular tachycardia].

PURPOSE: The aims of this study were to observe change in subjective symptoms, quality of life (QOL) and mental health condition after catheter ablation (CA) for paroxysmal supraventricular tachycardia (PSVT) and to assess patient evaluation of the treatment. METHODS: The questionnaire was sent to 103 patients (86 with the Wolff-Parkinson-White (WPW) syndrome and 27 with atriovetricular nodal reentrant tachycardia (AVNRT)), who had received CA from February 1995 to January 1999. The question encompassed the condition of the patient, his or her evaluation of CA treatment, and a self-rating depression scale (SDS) together with social and subjective as well as non-specific physical points. We scored for improvement of QOL and SDS. Finally, from 82 patients who participated complete responses to the questionnaire were received from 59 (72.0%). The patients (50.5 +/- 15.8 years old, WPW syndrome; 41, AVNRT; 18) almost all (98.3%) RESULTS: gave a positive evaluation of CA. Over half (54.2%) no longer needed hospital consultation for any reason while three-quarters (76.3%) were free of life limitations. The complete cure rate from physicians was 100%. However, subjective symptoms of arrhythmia attack remained in 20.3% of the cases. Social and physical QOL were significantly improved after CA (social: < 0.05, physical: < 0.01) and the SDS score decreased significantly (< 0.05). 1. Self-awareness frequency of tachycardia attack, frequency of going to hospital and life CONCLUSION: limitations of PSVT patients decreased after CA. 2. QOL (social and physical QOL) and mental health condition significantly improved after CA. 3. Almost all patients (98.3%) gave a positive evaluation of CA. 4. Healthcare professionals should be aware that not only drug therapy, but also CA is effective for improvement of mental health and the QOL of patients with PSVT.