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Sofosbuvir plus ribavirin combination was associated with a high rate of complete clinical response and a low rate of serious adverse events in HCV-cryoglobulinaemia vasculitis.

We have analyzed the molecular dynamics of emergence of drug-resistant strains in patients receiving lamivudine therapy for chronic hepatitis B. Twenty consecutive patients with lamivudine resistance were studied ( Major advances in the antiviral treatment of chronic hepatitis B have been made with the development of new antiviral compounds that inhibit the reverse transcriptase activity of hepatitis B virus (HBV). Recently, lamivudine has been approved for the therapy of chronic hepatitis B. Results of clinical trials in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B showed that lamivudine administration was associated with an increased rate of HBV-DNA clearance and antibody to hepatitis B e antigen (anti-HBe) seroconversion together with a significant improvement in liver histology, by comparison with patients who received placebo. [1][2][3][4] In patients infected with a precore mutant associated with an HBeAg-negative chronic hepatitis B, lamivudine therapy for 12 months was also associated with HBV-DNA suppression, normalization of alanine transaminase (ALT) levels, and improvement in liver histology in approximately 60% of patients. 5 In liver transplant recipients with HBV recurrence on the liver graft, lamivudine therapy for 52 weeks allowed suppression of viral replication in 60% of patients. 6 However, in immune competent patients, selection of lamivudine-resistant strains, which may lead to failure of antiviral therapy of chronic hepatitis B, occurs in approximately 16% to 43% of the patients treated for 1 year. 2-5 Selection of drugresistant mutants has also been observed in human immunodeficiency virus (HIV)-HBV coinfected patients treated with lamivudine for their HIV infection 7 and in liver transplant recipients treated with lamivudine for HBV recurrence on the liver graft. 6 Drug resistance is associated with a rise in serum HBV-DNA titers above the detection limit of the assay, which is commonly referred to as phenotypic resistance. In these trials, appearance of viral resistance starts after 6 months of treatment and increases with the duration of treatment. Despite phenotypic resistance, HBV-DNA levels and ALT levels remained lower by comparison with baseline values. In the majority of these patients, lamivudine resistance was not associated with significant clinical or histologic worsening. [2][3][4]6 However, some patients showed clinical deterioration with liver failure, especially in the liver transplantation setting. 6,8 Viral resistance is associated with the selection of major mutations in the YMDD motif within the C domain of the viral reverse transcriptase, and in the conserved B domain. These mutants have been classified in group I with B and C domain Abbreviations: HBV, hepatitis B virus; HBeAg, hepatitis B e antigen; anti-HBe, antibody to hepatitis B e antigen; ALT, alanine transaminase; HIV, human immunodeficiency virus; ULN, upper limit of normal; bDNA, branched DNA; PCR, polymerase chain reaction; HBsAg, hepatitis B surface antigen.From 1 INSERM Unit 2...

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In a long-term follow-up analysis of data from a clinical trial, we found that more than 95% of patients with HCV-CryoVas have a full or partial response of symptoms to different DAA treatment regimens. Fewer than 5% of patients stop therapy prematurely and less than 3% die. A severe form of CryoVas and peripheral neuropathy were associated with a lack of response of HCV-CryoVas to DAA therapy.