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 28 May 2018

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Hepatitis B

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I have a 32-year-old Asian woman with chronic HBV infection (HBeAg-positive with only minor signs at liver biopsy and ALT more than twice the upper limit of normal). She has been treated now for 1 year with lamivudine 100 mg daily. So far, she has responded well to treatment (HBV DNA level lowered by PCR from 276,000 to 10,000 copies/ml; normalization of ALT). However, she has remains positive for HBeAg.

She and her husband would like to have a child. They therefore ask whether the lamivudine could be stopped now. What can I suggest to them? Should she continue lamivudine, suspend treatment, or replace lamivudine with adefovir?

Bertrand Martinez-Aussel, Vientiane, Laos  

Lamivudine and adefovir are both pregnancy schedule C drugs ("animal studies show adverse fetal effects, but no human studies available; weigh possible fetal risk versus maternal benefit").

My usual practice is to stop lamivudine, or adefovir, in women wishing to initiate pregnancy, as well as in their male partners. Her liver chemistries should be monitored during the first few months after discontinuation of lamivudine, since flares of liver disease, usually mild but rarely severe, have been reported. Since adefovir is also a schedule C drug, it should not be substituted for lamivudine.


Emmet Keeffe, Stanford, CA, USA  

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