A Preliminary Study On Chronic Hepatitis B With Primary Non-response To Lamivudine

Objective To investigate the emergence,development and influencing factors of chronic Hepatitis B which is primary non-response to lamivudine,and corresponding treatment.Methods The influencing factors of primary non-response to lamivudine were studied on 202 chronic Hepatitis B patients who had got lamivudine therapy more than 1 year.46 non-responsers were classified into two groups according to with/without YMDD mutation.The two groups were treated with lamivudine plus adefovir or not.The therapeutic effects and evolution of YMDD mutations were monitored and compared.Results The rate of occurring primary non-response to lamivudine was 46/202(22.8%).Compared with HBeAg negative individuls,HBeAg positive patients had more possibility of non-response to lamivudine(P=0.0019).YMDD mutation were detected on 23 non-responsers(50%).There was obvious difference between the group which had the decline of HBV-DNA less than 3 log₁₀and that more than 3 log₁₀in intial viral response(P=0.0000).The baseline of HBV-DNA before treatment had less influence on occurring primary non-response(P＞0.05).But the lower the baseline of ALT,the easier non-response to lamivudine(P=0.0213).The genotype of HBV had no relationship with non-response(P=0.2483).In the LAM+ADV combination treatment,non-responsers with YMDD mutation were more likelihood to achieve HBV-DNA negative than those without YMDD mutation in the end (P=0.0228).Conclusion The influencing factors of chronic hepatitis B patients occurring primary non-response to lamivudine include HBeAg positive,YMDD mutation,the decline of HBV-DNA in the initial treatment(12 weeks)and the baseline level of ALT before treatment.There is no obvious correlation with the baseline level of HBV-DNA or HBV genotypes.The combination treatment of lamivudine and adefovir are more effective to primary non-responsers with YMDD mutation than those without YMDD mutation.