Successful combination therapy of interferon-alpha (IFN-α) with lamivudine in IFN-resistant chronic hepatitis B

A 28-year-old man with hepatitis Be antigen positive chronic hepatitis B was retreated for high hepatitis B virus (HBV)-DNA levels due to an unsatisfactory course with IFN-β in 1997, and IFN-α (HLBI) 6 MIU, following IFN-β with recombinant IFN-α in 1998. In July 1999, the patient switched to consecutive IFN-α (BALL-1) 5 MIU daily for two weeks, and then, three times a week. In January 2000, month 5 of retreatment, seroconversion developed with HBV-DNA positivity (by TMA method). We tried lamivudine (LAM) 100 mg daily from December 2000 with the above IFN. One month after combination, his HBVDNA levels had become undetectable (by TMA), and IFN was discontinued. In May 2001, month 6 of LAM intervention, his ALT normalized with undetectable HBV-DNA levels (by real-time PCR). His ALT levels were normal with HBV-DNA negativity (by TMA) for a six-month period. He could eventually go off LAM treatment in October 2001. As of April 2002, month 6 of LAM termination, his ALT values remained within the normal range and he was HBV-DNA negative (by TMA and real-time PCR). This good clinical course suggests that long-term IFN therapy combined with LAM follow-up may be one of the best therapies for incurable IFN-resistant hepatitis B.