The prevention of an expected hepatic flare in HBe negative patients after lamivudine discontinuation.

The treatment with lamivudine leads to drug resistant mutations in 19 to 70% cases after 1- and 5-year therapy, respectively, associated with the risk of severe rebound of liver disease with alaninaminotransferase flare. In this situation, adefovir should be added, but this drug is not available in every country. We report three cases where we avoided the expected hepatic flare-ups by using IFN and isoprinosine. Based on this empirical experience, we suggest that the new drug has to be administered one month before discontinuation of lamivudine. Prospective trials are mandatory.