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We read with interest the paper by Zoutendijk et al who found that entecavir-induced virological response (VR) reduces the probability of liver disease progression (LDP) in chronic hepatitis B (CHB) patients with cirrhosis. They also found previous lamivudine treatment not to be a significant risk factor,1 but as a large number of lamivudine-experienced CHB patients exist, the impact of different types of lamivudine exposure on entecavir resistance in entecavir-treated real-world patients is not well documented, and can lead to suboptimal VR, virological breakthrough and entecavir resistance. We report here our long-term study, from 2005 to 2011, of 300 real-world entecavir-treated CHB patients, including 90 (30%) nucleos(t)ide-experienced cases. The baseline demographics are shown in table 1. Mean duration of entecavir therapy and follow-up was 30.5 (95% CI 28.6 to 32.4) and 32.7 (95% CI 30.8 to 34.6) months, respectively.
The cumulative probability of entecavir-induced VR was 96.5% by year 4. Similar to Zoutendijk's study, baseline liver disease severity did not influence VR rates in our cohort (p=0.72). Using Cox regression correcting for baseline factors, like lamivudine exposure and cirrhosis, only HBeAg-negative status (HR=2.07; 95% CI 1.56 to 2.75; p<0.001) and lower Hepatitis B …