Antiviral therapy history, serological characteristics, and entecavir salvage therapeutic effect in HBVrtA181T/V mutant patients with chronic hepatitis B

XUE Yan; WANG Lei; ZHANG Lixin; LIU Feng; QU Yundong; YANG Baohua; LI Tao; WANG Yan; YE Qian; GAO Lin

doi:10.3969/j.issn.1002-266X.2017.40.001

Abstract：Objective To observe the history of antiviral therapy , serological characteristics , and entecavir salvage therapeutic effect in the hepatitis B virus ( HBV) reverse transcriptase ( RT) 181 site T/V mutant patients with chronic hepatitis B.Methods Seventy-one patients with virological breakthrough of nucleoside (acid) analogues (NAs)-resistant hepatitis B were continuously enrolled .Using direct sequencing for HBV sequencing , and we confirmed the presence of HBV reverse transcriptase region 181 site mutation of T/V, including 41 cases of HBV reverse transcriptase region 181 site mutation of T (rtA181T), and 30 cases of HBV reverse transcriptase region 181 site mutation of V (rtA181V).The medi-cation history of NAs in 71 patients was reviewed .The levels of serum ALT , HBsAg, and HBV-DNA were detected and compared in rtA181T and rtA181V patients during virological breakthrough .All patients were treated with entecavir-based antiviral therapy, and then we compared the virological response of rtA 181T and rtA181V patients at 24 and 52 weeks. Results Of the 71 patients, 25 patients were treated with a single antiviral drug (adefovir dipivoxil), and 46 patients with sequential or combined use of multiple NA .When the HBV rtA181T and rtA181V patients had virological breakthrough , the levels of serum ALT were 55 (15, 474) and 49 (16,183) U/mL, respectively, P>0.05; the log10 of HBV-DNA were 5.71 ±1.02 and 6.04 ±0.97, respectively, P<0.05; the log10 of serum HBsAg were 3.36 ±0.50 and 3.64 ± 0.60, P<0.05.Salvage therapy with entecavir was mainly for 24 weeks.The complete virologic response was found in 55 cases (77.5%), including 33 cases (80.5%) of HBV rtA181T patients and 22 cases (73.3%) of HBV rtA181V pa-tients;incomplete virologic response was found in 16 cases (22.5%).After 52 weeks of treatment, the complete virologic response was found in 62 cases (87.3%), including 37 cases (90.2%) of HBV rtA181T patients and 25 cases (83.3%) of HBV rtA181V patients;incomplete virologic response was found in 9 cases (12.7%), and no significant difference was found in the virologic response between the HBV rtA 181T and rtA181V patients (P>0.05).Conclusions Patients with HBV rtA181T/V mutation are mostly treated with sequential or combined with adefovir dipivoxil , lamivudine and other NAs.Serum HBsAg is higher in HBV rtA181V patients than in patients with HBV rtA 181T.The treatment effect of HBV rtA181T/V patients treated with entecavir salvage is satisfactory , but the treatment effect is not different between HBV rtA181T and HBV rtA181V patients.