Jaeckel E, Manns M P
Department of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Germany.
Intervirology. 1997;40(5-6):322-36. doi: 10.1159/000150565.
After several nucleoside analogues have been tested against chronic hepatitis B virus (HBV) infection with minimal success, lamivudine seems to be a highly effective new therapeutic option. This review focuses on nucleoside metabolism and on the molecular action of lamivudine as well as on results of clinical studies for several indications. We report on results of trials on the use of lamivudine for chronic HBV infection, chronic HBV under immunosuppression and prophylaxis or treatment of HBV reinfection before or after orthotopic liver transplantation. Aspects of combination therapy of different nucleoside analogues as well as on combination of lamivudine with interferon are also highlighted. Although lamivudine seems to be highly effective in most patients at the start of therapy, development of resistance by mutations in the viral polymerase is a significant clinical problem. The mode of resistance development is compared with the situation in HIV infection. Possible cross-resistance with other nucleoside analogues and the perspectives of lamivudine therapy are also considered.
在几种核苷类似物针对慢性乙型肝炎病毒（HBV）感染进行测试但收效甚微之后，拉米夫定似乎是一种高效的新治疗选择。本综述重点关注核苷代谢、拉米夫定的分子作用以及针对多种适应症的临床研究结果。我们报告了拉米夫定用于慢性HBV感染、免疫抑制状态下的慢性HBV以及原位肝移植前后HBV再感染的预防或治疗的试验结果。不同核苷类似物联合治疗以及拉米夫定与干扰素联合治疗的相关方面也得到了强调。尽管拉米夫定在治疗开始时对大多数患者似乎非常有效，但病毒聚合酶突变导致的耐药性发展是一个重大的临床问题。将耐药性发展模式与HIV感染情况进行了比较。还考虑了与其他核苷类似物可能的交叉耐药性以及拉米夫定治疗的前景。
