title: Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B.
abstract: The prognosis of decompensated cirrhosis resulting from chronic hepatitis B is poor, and the benefits of treatment with interferon are outweighed by serious side effects and by the risk of fatal exacerbation of disease activity. Lamivudine rapidly reduces hepatitis B virus (HBV)-DNA in serum to undetectable levels. We have treated 35 patients with chronic hepatitis B and decompensated cirrhosis with lamivudine 100 mg or 150 mg orally once daily. Pretreatment, all were positive for HBV-DNA in serum. Ten had Child-Pugh class B and 25 had Child-Pugh class C liver disease. Seven patients underwent liver transplantation within 6 months of treatment initiation, 5 patients died within 6 months, and 23 patients were treated for at least 6 months (mean = 19 months). In a majority of these 23 cases, there was a slow but marked improvement in liver function, which was most apparent after 9 months of treatment, with a decrease in serum bilirubin from 67 +/- 13 to 30 +/- 4 micromol/L (P <.05, baseline vs. 9 months), an increase in serum albumin from 27 +/- 1 to 34 +/- 1g/L (P <.05), and a decrease in Child-Pugh score from 10.3 +/- 0.4 to 7.5 +/- 0.5 (P <.05). Three patients developed resistance to lamivudine because of a mutation in the YMDD motif, but liver function did not deteriorate. We conclude that inhibition of viral replication with lamivudine results in a significant improvement of liver function in patients with decompensated HBV cirrhosis, but the long-term benefits remain uncertain.
authors.affiliation: Division of Hepatology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada. villej@sympatico.ca
authors.forename: J P
authors.initials: JP
authors.lastname: Villeneuve
authors.forename: L D
authors.initials: LD
authors.lastname: Condreay
authors.forename: B
authors.initials: B
authors.lastname: Willems
authors.forename: G
authors.initials: G
authors.lastname: Pomier-Layrargues
authors.forename: D
authors.initials: D
authors.lastname: Fenyves
authors.forename: M
authors.initials: M
authors.lastname: Bilodeau
authors.forename: R
authors.initials: R
authors.lastname: Leduc
authors.forename: K
authors.initials: K
authors.lastname: Peltekian
authors.forename: F
authors.initials: F
authors.lastname: Wong
authors.forename: M
authors.initials: M
authors.lastname: Margulies
authors.forename: E J
authors.initials: EJ
authors.lastname: Heathcote
mesh_terms: D001663:Bilirubin / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D001663:Bilirubin