Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2011; 17(43): 4804-4809
Published online Nov 21, 2011. doi: 10.3748/wjg.v17.i43.4804
De novo combination therapy with lamivudine and adefovir dipivoxil in chronic hepatitis B patients
Xiao-Hong Fan, Jian-Zhang Geng, Li-Fen Wang, Ying-Ying Zheng, Hai-Ying Lu, Jing Li, Xiao-Yuan Xu
Xiao-Hong Fan, Li-Fen Wang, Ying-Ying Zheng, Hai-Ying Lu, Xiao-Yuan Xu, Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
Jian-Zhang Geng, Jing Li, Department of Infectious Diseases, Shijiazhuang Fifth Hospital, Shijiazhuang 050021, Hebei Province, China
Author contributions: Xu XY, Lu HY, Fan XH and Geng JZ designed the research; Fan XH, Geng JZ, Wang LF, Zheng YY and Li J performed the research; Fan XH analyzed the data and wrote the manuscript.
Supported by Glorious Funds from Chinese foundation for hepatitis prevention and control, No. GHF2010205
Correspondence to: Xiao-Yuan Xu, Professor, Department of Infectious Diseases, Peking University First Hospital, No. 1, Dahongluochang Street, Xicheng District, Beijing 100034, China. yangpin@public3.bta.net.cn
Telephone: +86-10-83575019 Fax: +86-10-66551799
Received: March 18, 2011
Revised: May 18, 2011
Accepted: May 25, 2011
Published online: November 21, 2011
Abstract

AIM: To investigate the appropriate time for combination therapy in HBeAg positive chronic hepatitis B (CHB) patients with decompensated cirrhosis.

METHODS: Thirty HBeAg positive CHB patients with decompensated cirrhosis were enrolled in the study. All of the patients were given 48 wk combination therapy with lamivudine (LAM) and adefovir dipivoxil (ADV). Briefly, 10 patients were given the de novo combination therapy with LAM and ADV, whereas the other 20 patients received ADV in addition to LAM after hepatitis B virus (HBV) genetic mutation.

RESULTS: Serum alanine aminotransferase and total bilirubin were both improved in the two groups at 4, 12, 24 and 48 wk after treatment. Serum albumin was also improved at 24 and 48 wk after combination therapy in both groups. The serum HBV DNA level was still detectable in every patient in the two groups at 4 and 12 wk after combination treatment. However, in the de novo combination group, serum HBV DNA levels in 4 (40%) and 9 (90%) patients was decreased to below 1×103 copies/mL at 24 and 48 wk after the combination treatment, respectively. In parallel, serum HBV DNA levels in 2 (20%) and 8 (40%) patients in the add-on combination group became undetectable at 24 and 48 wk after combination treatment, respectively. Furthermore, 6 (60%) patients in the de novo combination group achieved HBeAg seroconversion after 48 wk treatment, whereas only 4 (20%) patients in the add-on combination group achieved seroconversion. Child-Pugh score of patients in the de novo combination group was better than that of patients in the add-on combination group after 48 wk treatment. Moreover, patients in the de novo combination group had a significantly decreased serum creatinine level and elevated red blood cell counts.

CONCLUSION: De novo combination therapy with LAM and ADV was better than add-on combination therapy in terms of Child-Pugh score, virus inhibition and renal function.

Keywords: Hepatitis B, Chronic, Cirrhosis, Decompen-sated, De novo combination, Lamivudine, Adefovir di-pivoxil