Comparison of adefovir and tenofovir in the treatment of lamivudine-resistant hepatitis B virus infection

Authors

  • Florian van Bömmel,

    1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Thomas Wünsche,

    1. Medizinische Klinik mit Schwerpunkt Infektiologie und Asthma-Poliklinik, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Stefan Mauss,

    1. Zentrum für HIV und Hepatogastroenterologie, Düsseldorf, Germany
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  • Petra Reinke,

    1. Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Alexandra Bergk,

    1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Dirk Schürmann,

    1. Medizinische Klinik mit Schwerpunkt Infektiologie und Asthma-Poliklinik, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Bertram Wiedenmann,

    1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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  • Thomas Berg

    Corresponding author
    1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
    • Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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    • fax: (49) 30-450-553903


  • Presented in part at the 54th Annual Meeting of The American Association for the Study of Liver Diseases, October 24–28, 2003, Boston, MA (Abstract 246).

Abstract

Adefovir dipivoxil was recently approved for the treatment of wild-type and lamivudine-resistant hepatitis B virus (HBV) infection. Tenofovir disoproxil fumarate, a congender of adefovir that is used in the treatment of HIV infected patients, has recently been shown to also be effective in patients with lamivudine-resistant HBV infection. We therefore compared the two substances in a study of 53 patients defined by high HBV DNA (>6 log10 copies/mL) levels and genotypic evidence of lamivudine resistance. Thirty-five patients received tenofovir for 72 to 130 weeks, and 18 received adefovir for 60 to 80 weeks. Changes in HBV DNA levels were followed for the complete period of 48 weeks. Early viral kinetics were compared on matched subgroups of 5 patients each. Individually, all tenofovir-treated patients showed a strong and early suppression of HBV DNA within a few weeks whether they were coinfected with HIV or were without comorbidity. In contrast, considerable individual variations in HBV DNA decline were observed in the adefovir group. Thus at week 48, only 44% of these patients had HBV DNA levels below 105 copies/mL in contrast to 100% of the tenofovir-treated patients (P = .001). No severe side effects were noticed in either group. No evidence of phenotypic viral resistance could be demonstrated in the tenofovir-treated patients in the long term (up to 130 weeks). In conclusion, tenofovir may become an effective alternative for the treatment of patients with lamivudine-resistant HBV infection. (HEPATOLOGY 2004;40:1421–1425.)

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