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TENOFOVIR EFFECTIVELY INHIBITS VIRAL REPLICATION IN DIFFERENT PATIENT GROUPS
WITH LAMIVUDINE RESISTANT HBV INFECTION
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F. van Bommel*, 1 T. Wunsche, 2 D. Schurmann, 2 K. Reinke, 3 B. Wiedenmann,
1 U. Hopf, 1 T. Berg, 1
*Presenting Author
1Medizinische Klinik M. S. Hepatologie Und Gastroenterologie, Charite Campus
Virchow Klinikum, 2Medizinische Klinik M. S. Infektiologie, Charite Campus
Virchow Klinikum, 3Medizinische Klinik M. S. Nephrologie Und Internistische
Intensivmedizin, Charite Campus Virchow Klinikum, Berlin, Germany
The development of resistant mutants during the course of lamivudine-therapy
is often associated with progression of chronic hepatitis B virus (HBV)
infection. In a pilot-study we could demonstrate that tenofovir, an acyclic
nucleotid-analogue and congender of adefovir affects lamivudine-resistent HBV
replication in vivo with high efficacy. The aim of this study was to document
long-term effectiveness and safety of tenofovir in different patients groups
with chronic HBV-infection. 19 patients (10 HBV/HIV-coinfected, 4 patients
with chronic HBV-infection after renal transplantation, and 5 with chronic
hepatitis B; mean age 49 years [47-58]) who suffered viral breakthrough after
2-3 years of lamivudine-therapy were included in the study. All patients
received 245 mg tenofovir daily for at least 24 weeks (mean 53, 7 weeks,
range 24-72 weeks). At baseline, HBV DNA levels were > 20 x 106 copies/ml
(HBV-Monitor, Roche) in all patients. Lamivudine-resistant mutations within
the polymerase-gene were detected using a Line Probe Assay (INNO-LIPA HBV DR,
Innogenetics).
During tenofovir treatment a mean log decline of 3.7 ± 0.87 (range:
2.82-4.83) of HBV viremia was shown and HBV DNA became undetectable in 17/19
patients by the quantitative assay. No severe or clinically relevant side
effects were observed. Viral resistance to tenofovir was not observed during
the follow-up of up to 72 weeks, although the number of mutations in the YMDD
motif increased in patients in whom lamivudine treatment was maintained. The
results demonstrate that tenofovir has a significant suppressive effect on
the replication of lamivudine-resistant HBV-mutants even in immune-suppressed
patients.
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