Late Failure of Combined Recombinant Hepatitis B Vaccine
Late Failure of Combined Recombinant Hepatitis B Vaccine
We report the first case of a woman having chronic hepatitis B treated with a combination therapy of recombinant hepatitis B vaccine and lamivudine for 18 months. The main aims of such a combined therapy were to assess whether the concomitant anti-hepatitis B virus (HBV) vaccination might prevent the emergence of a mutant HBV and lead to sustained hepatitis B e antigen seroconversion with undetectable serum HBV DNA. The data from the present case demonstrated that combination of anti-HBV vaccine and lamivudine did not eliminate viral DNA despite prolonged treatment and did not have any effect on preventing resistant-type HBV. Although the combined therapy failed to reach the therapeutic endpoints, it concerned a single and unique patient. Hepatitis B vaccine and lamivudine for HBV treatment should be further investigated in randomized controlled trials.
The development of new nucleoside analogues that inhibit hepatitis B virus (HBV) reverse-transcriptase activity, such as lamivudine, famciclovir, and others, has recently provided an alternative to interferon therapy for chronic hepatitis B. However, antiviral therapy of HBV infection faces the problem of viral persistence and resistance to nucleoside analogues. In view of the limited efficacy of lamivudine monotherapy for chronic hepatitis B infection, the capacity of new antiviral strategies based on combination of new inhibitors, including adefovir and entecavir, with immune modulators needs to be further evaluated to prevent the emergence of resistant viral strains.
Administration of vaccine containing hepatitis B surface antigen (HBsAg) alone has shown complete clearance or reduction of HBV DNA, clearance of hepatitis B e antigen (HBeAg), and development of antibodies to hepatitis B e antigen (anti-HBe) in more than one third of chronic HBV carriers. Thus, vaccination could be the therapeutic option with the lowest cost and potentially the greatest benefit, because boosting immune system response to HBV vaccine may offer an advantage to some patients who are infected with the virus and receive lamivudine treatment for it. For this purpose, we aimed to evaluate the efficacy of therapeutic immunostimulation in a chronic hepatitis B patient who received 18 monthly intramuscular vaccinations with HBsAg/pre-S2 in combination with daily lamivudine.
We report the first case of a woman having chronic hepatitis B treated with a combination therapy of recombinant hepatitis B vaccine and lamivudine for 18 months. The main aims of such a combined therapy were to assess whether the concomitant anti-hepatitis B virus (HBV) vaccination might prevent the emergence of a mutant HBV and lead to sustained hepatitis B e antigen seroconversion with undetectable serum HBV DNA. The data from the present case demonstrated that combination of anti-HBV vaccine and lamivudine did not eliminate viral DNA despite prolonged treatment and did not have any effect on preventing resistant-type HBV. Although the combined therapy failed to reach the therapeutic endpoints, it concerned a single and unique patient. Hepatitis B vaccine and lamivudine for HBV treatment should be further investigated in randomized controlled trials.
The development of new nucleoside analogues that inhibit hepatitis B virus (HBV) reverse-transcriptase activity, such as lamivudine, famciclovir, and others, has recently provided an alternative to interferon therapy for chronic hepatitis B. However, antiviral therapy of HBV infection faces the problem of viral persistence and resistance to nucleoside analogues. In view of the limited efficacy of lamivudine monotherapy for chronic hepatitis B infection, the capacity of new antiviral strategies based on combination of new inhibitors, including adefovir and entecavir, with immune modulators needs to be further evaluated to prevent the emergence of resistant viral strains.
Administration of vaccine containing hepatitis B surface antigen (HBsAg) alone has shown complete clearance or reduction of HBV DNA, clearance of hepatitis B e antigen (HBeAg), and development of antibodies to hepatitis B e antigen (anti-HBe) in more than one third of chronic HBV carriers. Thus, vaccination could be the therapeutic option with the lowest cost and potentially the greatest benefit, because boosting immune system response to HBV vaccine may offer an advantage to some patients who are infected with the virus and receive lamivudine treatment for it. For this purpose, we aimed to evaluate the efficacy of therapeutic immunostimulation in a chronic hepatitis B patient who received 18 monthly intramuscular vaccinations with HBsAg/pre-S2 in combination with daily lamivudine.
Source...