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Emergence of adefovir-resistant mutants after reversion to YMDD wild-type in lamivudine-resistant patients receiving adefovir monotherapy.

Kwon, HC; Cheong, JY; Cho, SW; Choi, JM; Hong, SP; Kim, SO; Yoo, WD
Journal of gastroenterology and hepatology, 24(1):49-54, 2009
Journal Title
Journal of gastroenterology and hepatology
BACKGROUND: To evaluate the effect of reversion to YMDD wild-type on emergence of adefovir (ADV)-resistant mutation and antiviral activity of ADV in lamivudine (LAM)- resistant patients. METHODS: We determined YMDD mutations and ADV-resistant mutations before and every 3 months during ADV monotherapy in 33 LAM-resistant patients using the restriction fragment mass polymorphism (RFMP) method. RESULTS: Reversion to pure YMDD wild-type hepatitis B virus (HBV) occurred in 6% (2/33), 9% (3/33), 20% (4/20) and 35% (6/17) of patients after 12, 24, 36 and 48 weeks, respectively. Five (29%) patients were found to have pure YMDD mutants at 48 weeks of therapy. Among 33 patients, 4 (12%) patients developed ADV-resistant mutations at 48 weeks of therapy. Adefovir-resistant mutants emerged in all patients after reversion to YMDD wild-type HBV. The mean serum HBV reductions, evaluated at 24 weeks of therapy, were not different between patients with and without reversion to YMDD wild-type HBV (-3.1 log(10) copies/mL vs-3.4 log(10) copies/mL, P > 0.05). CONCLUSIONS: ADV-resistant mutations emerged after reversion to YMDD wild-type in LAM-resistant patients who received ADV monotherapy. Thus, ADV add-on therapy may be necessary to reduce the incidence of developing ADV resistance in patients with LAM resistance.
MeSH terms
Adenine/analogs & derivatives*Adenine/therapeutic useAdultAntiviral Agents/therapeutic use*DNA, Viral/bloodDrug Resistance, Multiple, Viral/genetics*FemaleHepatitis B/diagnosisHepatitis B/drug therapy*Hepatitis B virus/genetics*HumansLamivudine/therapeutic use*MaleMiddle AgedMutation*Phosphonic Acids/therapeutic use*Polymorphism, Restriction Fragment LengthSpectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationTime FactorsTreatment OutcomeViral Load
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Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
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