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Lamivudine
Shows Benefits in HBV Suppression and Significantly Improves Liver
Function in Patients with HBV-related Decompensated Liver Cirrhosis
Chronic
hepatitis B infection (HBV) is a major health problem worldwide.
The prognosis is grave for patients with HBV-related decompensated
liver cirrhosis (LC).
Researchers evaluated the effectiveness and the
determinants of early mortality of lamivudine
(Epivir-HBV) treatment in patients
with HBV-related decompensated LC.
Results
· Thirty
patients with HBV-related decompensated LC and active viral replication
were treated with lamivudine 100 mg daily for a median duration
of 9 months.
· Among
these patients, five patients died within 3 months.
· Two
patients were lost to follow-up at week 8 and 9. One patient was
treated for <6 months.
· Twenty-two
patients were treated over 6 months. Univariate analysis revealed
that the total bilirubin (P = 0.008), prothrombin
time (P = 0.004), Child TurcottePugh score (P = 0.005),
the model of end-stage
liver disease
score (P = 0.004) and stage III hepatic encephalopathy
(P = 0.001) were predictive factors of early mortality.
· Multivariate
analysis revealed that the independent factor associated with early
mortality was stage III encephalopathy.
· Among
22 patients, liver function improved markedly after lamivudine therapy.
· Of
the nine hepatitis
B e antigen (HBeAg)-positive patients, three had HBeAg seroconversion.
· Two
patients had YMDD
mutant
and virological breakthrough at 41 and 46 weeks.
· One
of the two had hepatocellular
carcinoma
and died of hepatic
failure
at week 125; the other received adefovir
dipivoxil (Hepsera)
and is doing well.
Based on these findings, the authors conclude, “Lamivudine
appeared to have benefits in viral suppression and significant improvement
in liver function in patients with HBV-related decompensated LC.”
“As noted in prior studies, poor baseline liver function is
associated with a poor prognosis in Asian patients with decompensated
HBV cirrhosis treated with lamivudine.”
07/08/05
Reference
P
Tseng and others. Determinants of early mortality and benefits of lamivudine therapy in patients
with hepatitis B virus-related decompensated liver cirrhosis. Journal
of Viral Hepatitis 12(4):
386-392. July 2005.
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