Clinical outcome and virologic profiles of severe hepatitis B exacerbation due to YMDD mutations

J Hepatol. 2003 Nov;39(5):850-5. doi: 10.1016/s0168-8278(03)00388-x.


Background/aims: To study the outcome and the virologic profiles of severe hepatitis exacerbations due to YMDD mutants in lamivudine-treated patients.

Methods: Eighteen lamivudine-treated patients with severe hepatitis exacerbations due to YMDD mutants were recruited. Laboratory and clinical parameters were monitored. Viral genotypes and YMDD mutations were determined.

Results: None of the 18 patients had YMDD wild-type during exacerbations. Three (17%) and 15 (83%) patients had genotypes B and C, respectively. Elevated bilirubin levels and prolonged prothrombin time were found in 11 (61%) and six patients (33%) respectively. Three patients (17%) had adverse outcome with the development of ascites and/or encephalopathy. One of these patients required liver transplantation and one died. Both patients had evidence of cirrhosis before treatment and hepatitis B e antigen (HBeAg) seroreversion from anti-HBe positivity. The remaining 16 patients (89%) have no evidence of pre-existing cirrhosis. Thirty seven percent of patients had normal alanine aminotransferase levels at the last follow-up. The median HBV DNA level at the last follow-up was significantly lower than the pre-treatment level (P=0.009).

Conclusions: Though the majority of patients with severe hepatitis exacerbations due to YMDD mutants had uneventful course, early liver transplantation should be considered in patients with pre-existing cirrhosis and HBeAg seroreversion.

MeSH terms

  • Adult
  • Alanine Transaminase / metabolism
  • DNA, Viral / metabolism
  • Female
  • Genotype
  • Hepatitis B / drug therapy
  • Hepatitis B / genetics
  • Hepatitis B / physiopathology*
  • Hepatitis B / virology*
  • Hepatitis B virus / genetics*
  • Humans
  • Lamivudine / therapeutic use*
  • Male
  • Middle Aged
  • Mutation*
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Severity of Illness Index
  • Treatment Outcome


  • DNA, Viral
  • Reverse Transcriptase Inhibitors
  • Lamivudine
  • Alanine Transaminase