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HBV Mutant YMMDD
May 17, 2002

Dear Doctors,

I am confused. What should somebody start treatment with Epivir if it will cause a mutant virus? I have read here that about 40 of the cases can seroconvert, but do they have to continue treatment for ever, and if so, doesn't it make your body resistant to these drugs, and you will not be able to use them for any other diseases in the future, including AIDS? Thanks

Response from Dr. Fried

Lamivudine (Epivir) is a good drug for the treatment of hepatitis B (one of two drugs approved by the FDA for this indication, interferon is the other one). The issue of YMDD mutations is important and all the questions are not completely resolved. There is evidence to suggest that YMDD HBV mutants are less hardy than the wild-type virus and that levels of HBV DNA and ALT will still be lower than baseline, even after the develment of YMDD. HOWEVER, the long-term consequences of these mutations are not known. New drugs are being developed that work against the YMDD mutants (adefovir is one) and it is likely some combination of drugs, just like HIV therapy, will ultimately be the best regimen. All this needs to be proven in clinical trials.



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