24. Are the oral treatments for hepatitis B complimentary in treating resistance? (adefovir resistance and lamivudine)

Now what about people who get adefovir and develop the N236T mutation? Here are four patients who are on adefovir, they developed a mutation as confirmed at different points, and then they got switched to lamivudine and you can see the DNA level in each case drops down. Here, one patient had the A136V mutation, it drops down. So you might say to yourself, some of you know about the world of HIV. HIV also is a virus that is very prone to mutations. So how do we treat HIV? We treat HIV with a cocktail of several different drugs. And the reason that is done is to prevent resistance. And the HIV virus is even more prone to resistance as is the hepatitis B virus. So why don’t we use lamivudine and adefovir? Well the reason we don’t is because it escalates the cost and there is no added benefit in terms of the DNA lowering or the ALT. If we could prove or research shows that two oral agents make the liver better, make the DNA lower, then that’s probably where we’ll end up going.