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Lamivudine treatment for chronic hepatitis B infection

Children with chronic hepatitis B infection treated with lamivudine, following failure of interferon therapy, show decreased HBV replication and improved ALT values, find researchers in the March issue of the Pediatric Infectious Diseases Journal.

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Lamivudine is a potent inhibitor of hepatitis B virus (HBV) replication.

In this study, researchers from Israel assessed the results of lamivudine treatment in children with chronic hepatitis B infection who did not respond to interferon treatment.

Lamivudine (3 mg/kg/day) was given to 20 children and adolescents (aged 8 to 19 years) with chronic hepatitis B, for a period of 52 weeks. The children had previously been treated with interferon, between 2 and 5 years earlier.

The researchers evaluated virologic and biochemical responses, the occurrence of YMDD mutants, and adverse effects.

At the end of 1 year, HBV DNA declined by 95% in all patients.
Pediatric Infectious Diseases Journal

The team found that 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 44% had sustained undetectable HBV DNA by hybridization assay.

In addition, median pretreatment alanine aminotransferase (ALT) x 1.5 upper limit of normal, decreased to ALT x 0.9 upper limit of normal after 1 year.

Of the 20 children, 1 became HBeAg-negative.

However, the team detected YMDD mutants in 65% of 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.

Dr Corina Hartman's team concluded, "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."

Pediatr Infect Dis J 2003; 22(3): 224-9
14 March 2003

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