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Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2423–2431 | Cite as

Medication Nonadherence with Long-Term Management of Patients with Hepatitis B e antigen-Negative Chronic Hepatitis B

  • Nghiem B. Ha
  • Nghi B. Ha
  • Ruel T. Garcia
  • Huy N. Trinh
  • Kevin T. Chaung
  • Huy A. Nguyen
  • Khanh K. Nguyen
  • Brian S. Levitt
  • Mindie H. Nguyen
Original Article

Abstract

Background and Aims

Antiviral treatment responses for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) are well-defined by data from registration trials but may differ from patients seen in community settings where medical adherence is usually not as strictly monitored. The goal of this study was to examine the long-term outcomes of HBeAg-negative patients in a community clinical setting.

Methods

We performed a cohort study of 189 consecutive treatment-naïve patients with CHB who were treated with either entecavir (ETV) 0.5 mg daily (n = 107) or adefovir dipivoxil (ADV) 10 mg daily (n = 82) from 2002 to 2009 at two community clinics.

Results

All patients were Asians. Both ETV and ADV cohorts had similar median baseline ALT and HBV DNA levels. By year 4, a similar proportion of ETV and ADV patients who remained on monotherapy achieved complete viral suppression (91–96%); however, more patients in the ADV cohort required alternative therapy (27 vs. 5%). No patients in the ETV cohort developed resistance while 18% of the ADV cohort did. Cumulative nonadherence rates were 10 and 12% in ADV and ETV cohorts, respectively.

Conclusions

Failure to monotherapy in a community clinical setting is due to both antiviral resistance and patient nonadherence. Medication nonadherence is likely to be a more important contributor to treatment failure than antiviral resistance, especially with new anti-HBV agents such as ETV and tenofovir.

Keywords

HBeAg-negative Nonadherence Adefovir dipivoxil Entecavir Outcome 

Abbreviations

HBV

Hepatitis B virus

CHB

Chronic hepatitis B

PCR

Polymerase chain reaction

DNA

Deoxyribonucleic acid

HBeAg

Hepatitis B e antigen

HBsAg

Hepatitis B surface antigen

Anti-HBe

Hepatitis B e antibody

ADV

Adefovir dipivoxil

ETV

Entecavir

ICD-9

International classification of disease, 9th revision

IU

International unit

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

ULN

Upper limit of normal

Notes

Conflict of interest

None to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Nghiem B. Ha
    • 3
    • 1
  • Nghi B. Ha
    • 1
  • Ruel T. Garcia
    • 2
    • 1
  • Huy N. Trinh
    • 2
    • 1
  • Kevin T. Chaung
    • 1
  • Huy A. Nguyen
    • 2
  • Khanh K. Nguyen
    • 2
  • Brian S. Levitt
    • 2
  • Mindie H. Nguyen
    • 3
  1. 1.Pacific Health FoundationSan JoseUSA
  2. 2.San Jose GastroenterologySan JoseUSA
  3. 3.Division of Gastroenterology and HepatologyStanford University Medical CenterStanford, Palo AltoUSA

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