Lamivudine as an alternative therapy for interferon-resistant chronic hepatitis B and the characteristics of hepatitis B virus: A case report

A 27-year-old man who had been diagnosed as having chronic hepatitis B suff ered disease exacerbation with marked reactivation of hepatitis B virus (HB V). Treatment with interferon (IFN) did not improve his condition, and his serum HBV DNA level increased to over 10 000 pg/ml during IFN administratio n. Following replacement with lamivudine, there was a substantial reduction in HBV DNA to an undetectable level, and liver function parameters subsequ ently improved to within the normal range. Quantitative analysis of the pre core mutant HBV DNA, which is a variant that cannot express hepatitis B a a ntigen due to a G-to-A point mutation in the precore region of the viral ge nome, revealed that the amount present was greater than for the precore wil d-type HBV DNA in the serum taken before IFN treatment. This case suggests that lamivudine would be an appropriate alternative to IFN, particularly in patients infected with HBV containing an excess of precore mutants resista nt to IFN therapy.