Profile of HBV polymerase gene mutations during entecavir treatment in patients with chronic hepatitis B

Evaluation of the pol/S Gene Overlapping Mutations in Chronic Hepatitis B Patients in Northern Cyprus

Mutations associated with the pol and the S gene can emerge as a consequence of the high replication capacity and proofreading deficiencies of hepatitis B virus during replication. The current study was constructed to evaluate primary, partial, compensatory and the escape mutations in chronic hepatitis B patients in Northern Cyprus. The samples of HBsAg positive treatment naïve 100 patients were involved in this study. HBV pol gene region was sequenced, amplified and HBV pol/S gene mutations were determined. The samples of thirty-two patients were excluded because of their low viral load (HBV < 1000 ıu/ml). Among the sequenced 68 samples, there was a partial mutation (1.5%) and 36.7% displayed a resistance profile to lamivudine, adevofir, and telbivudine. Immune response escape, vaccine escape, HBIg and diagnosis escape mutations were determined in 24%, 10%, 6%, and 4% samples of the patients, respectively. Additionally, there were six different combined mutations. These data underscored that there is no concern for primary mutations in Northern Cyprus, however, we have identified a compensatory mutation (rtV173M) that may have primary mutation characteristics by combining with other mutation patterns. Additionally, HBsAg escape mutants demonstrated that detection of the S gene together with the pol gene mutations might be beneficial and important to monitor the surveillance of S variants.

Effect of entecavir and adefovir dipivoxil on thyroid function and liver function in patients with decompensated hepatitis B cirrhosis

AIM

To explore the effect of entecavir and adefovir dipivoxil on thyroid function and liver function in patients with decompensated hepatitis B cirrhosis.

METHODS

One hundred and twenty patients with decompensated hepatitis B cirrhosis treated from September 2014 to September 2016 at our hospital were randomly divided into an observation group (n = 60) and a control group (n = 60). Both groups received conventional treatment. The control group was additionally given adefovir dipivoxil, and the observation group was given entecavir. At 3, 6, and 12 mo after treatment, hepatitis B virus (HBV) DNA negative rate, HBeAg negative rate, Child-Pugh score, liver function, thyroid function, the incidence of complications, mortality, and the incidence of adverse drug reactions were observed.

RESULTS

At 3, 6, and 12 mo after treatment, HBV DNA negative rates were significantly higher in the observation group than in the control group (P < 0.05), although there was no significant difference in hepatitis B e antigen negative rates (P > 0.05); the Child-Pugh scores and serum levels of alanine transaminase, aspartate transaminase, and total bilirubin were significantly lower in the observation group than in the control group (P < 0.05). After treatment for 1 year, the levels of T3, T4, FT3, and FT4 were significantly higher and that of TSH was significantly lower in the observation group than in the control group (P < 0.05). There was no significant difference in the incidence of complications or mortality (P > 0.05), and no severe adverse reactions were observed in either group.

CONCLUSION

Entecavir is significantly effective in patients with decompensated hepatitis B cirrhosis and can improve liver function and thyroid function with good safety.

A different inhibitor is required for overcoming entecavir resistance: a comparison of four rescue therapies in a retrospective study

AIMS

Little clinical data are available regarding re-establishing the effective inhibition of entecavir (ETV)-resistant mutants. In this retrospective study, we aimed to compare the efficacies of four treatment regimens as rescue therapy for those chronic hepatitis B (CHB) patients with ETV resistance.

METHODS

A total of 65 patients with ETV resistance were assigned either with tenofovir disoproxil fumarate (TDF) monotherapy (n = 21), ETV (0.5 mg) plus adefovir (ADV) combination therapy (n = 19), ETV (1.0 mg) monotherapy (n = 11) or ETV (0.5 mg) plus TDF combination therapy (n = 14). The efficacy and safety of four treatment regimens were compared.

RESULTS

There were no significant differences among the four study groups in baseline characteristics, including HBV DNA levels (χ²  = 0.749, P = 0.862) and hepatitis B e antigen-positivity (χ²  = 0.099, P = 0.992). The median reduction in serum HBV DNA level from baseline at week 48 was -2.37 ± 1.07 log₁₀ IU ml^-1 , -2.16 ± 0.81 log₁₀ IU ml^-1 , -1.17 ± 1.23 log₁₀ IU ml^-1 and -2.49 ± 1.10 log₁₀ IU ml^-1 , respectively (F = 4.078, P = 0.011). The TDF group and ETV (0.5 mg) + TDF group have the highest undetectable HBV DNA rate (76.19% vs. 78.57%) compared to the ETV (0.5 mg) + ADV group and the ETV (1.0 mg) group (63.16% vs. 18.18%, respectively). Two patients in the ETV (1.0 mg) group experienced virological breakthrough at week 48 and was attributed to poor drug adherence.

CONCLUSIONS

TDF monotherapy appeared to deliver the highest undetectable HBV DNA rate in patients with ETV resistance, and ADV plus ETV combination therapy could be another choice for patients with financial restraint.