How do viral variants complicate lamivudine (3TC) treatment of hepatitis B (HBV) (Hep B)?

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

The emergence of viral variants is the major complication in hepatitis B disease. [83, 84] Approximately 15-30% of patients develop a mutation of the viral polymerase gene (the YMDD variants) after 12 months of treatment with 3TC; approximately 50% develop a mutation after 3 years of treatment with the drug, and as many as 70-100% develop a mutation with long-term therapy. However, continued treatment after the breakthrough with the variant type has been associated with lower HBV DNA levels, less aminotransferase activity, and histologic improvement. For these patients, discontinuation of treatment is accompanied by a reversion to a wild type of HBV and a flare of the disease.


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