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ON LAM (3 months) what next? ADEFOVIR and/or PegIFN
Aug 8, 2002

Dear Doctors,

My profile is as follows:

Diagnosed on Nov 2000. HBsAg POsitive HBcoreAB Positive HBsAB Negative HBvDNA Positive (26.000.000 copies-ml as of Nov 2000). 187.336.000 copies-ml as of Apr 2002). Feb 2002:ALT/AST = 276/126; Apr 2002:ALT/AST = 318/147. I started tratment (LAM) 20 days ago. My question is: I read that after 9 months the risk of getting the mutant YMDD become higher. If I stay for 3 months or until my viral load goes down to at least 18.733 (4 log reduction), it would be a sign that LAM is working and if so, I could switch or add Interferon. (I would like to try PegIFN.) Is this the right approach? What do you recommend? If Adefovir is available in the future, will it be better to try Adefovir than PegIFN? Thanks and kindest regards.

Response from Dr. Dieterich

Adefovir was approved yesterday and should be on the market in a few months and will work if HBV becomes resistant to lamivudine. The results of Peg and lamivudine also seem to be better than either alone. There is no clear best answer now. Combinations of anything will seem to be the answer to HBV like they are for HIV. DTD

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