2004•Journal of Pediatric Gastroenterology and NutritionRequires access
P0339 LAMIVUDINE TREATMENT AND YMDD MUTANTS EMERGENCE IN CARRIERS WITH PERINATALLY TRANSMITTED HEPATITIS B VIRUS INFECTION
Yen‐Hsuan Ni, Mei‐Hwei Chang, Fu‐Chen Huang, Tao Wu, Man‐Shan Kong, Hong‐Yuan Hsu, Ho‐Sheng Chen
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Abstract
Introduction: Previous studies showed lamivudine was equivalently effective in children and in adults in Western countries. In Taiwan, most of the children acquired HBV infection through the perinatal transmission. This different mode of transmission may cause different responses. We thus aimed to investigate the efficacy of lamivudine treatment in children with perinatally acquired HBV infection. Methods: Twenty-nine patients who were hepatitis B e antigen (HBeAg) seropositive for >6 months, ALT >1.3 times of upper normal value, received an openlabel, 52-week-long lamivudine treatment(3mg/kg/day, maximum 100mg/day). We also enrolled another 29 subjects who were regularly followed-up before the introduction of lamivudine as the control group. The control group was sex-, age-, liver function-, and HBeAg status-matched with the treatment group, but received no treatment. They were also evaluated one year after the onset of abnormal ALT. All mothers of both study groups were HBsAg carriers. ALT and HBV DNA were checked at the enrollment and at week 52 for both groups. A successful treatment was defined as the patients meet the following criteria at 52 weeks: (1) undetectable HBV DNA, (2) normal ALT, and (3) HBeAg seroconverted to anti-HBe. The YMDD mutants induced by lamivudine were also checked at 52 week. Results: For the lamivudine group, five patients (17%) achieved a successful treatment end point while the other 24 failed. 38% (11/29) of both groups achieved HBeAg seroconversion at week 52. YMDD mutants developed in 4 patients in the lamivudine group (14%), all of the them failed the treatment.Table 1: Patient characteristics in the lamivudine group and the control groupConclusion: Lamivudine treatment is not effective for HBV perinatally infected children to achieve a complete virologic, biochemical, and serologic responses in Taiwan. This mode of infection is a distinct feature from the Western studies and might be an adverse factor for lamivudine treatment.