[Treatment of chronic viral hepatitis B with lamivudine]

INTERFERON ALPHA AND LAMIVUDINE: Chronic hepatitis B is currently treated with interferon alpha and lamivudine. Lamivudine (marketed under the name Zeffix in France) is given in oral preparations and is excreted in the urine. It is rapidly effective against virus replication since, after a one-month treatment, hepatitis B DNA levels are negative in most of the treated patients. After 12 months, there is an improvement in liver histology.

The probability of effective treatment is greatest for patients with highly elevated transaminase levels and low hepatitis B DNA levels prior to treatment. Another advantage of lamivudine is the extremely low rate of side effects. The risk of a rebound in viral replication after withdrawal is a drawback together with the possible development of viral mutations of the polymerase gene, particularly after more than one year of treatment.

Lamivudine can be prescribed for patients with a contraindication or non-responsive to alpha interferon: liver transplantation candidates, organ graft recipients. For other cases, alpha interferon is the first line treatment of choice. If lamivudine is used too early, there is a risk the patients could no longer be transplanted after the development of mutations and major aggravation of liver function. Future perspectives include simultaneous or sequential use of antiviral agents.