Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection.
BACKGROUND
Exacerbation of chronic hepatitis B infection can lead to fulminant hepatic failure with a mortality of up to 90%.


OBJECTIVE
To evaluate the efficacy of lamivudine in the treatment of this subgroup of patients.


METHODS
Twenty-four patients with exacerbation of chronic hepatitis B infection and fulminant hepatic failure were treated with lamivudine, 100 mg daily. Hepatitis A, C, D and human immunodeficiency virus co-infections and hepatocellular carcinoma were excluded.


RESULTS
The median age was 53 years (range, 24-77 years) with a male predominance of 20:4. Seventeen patients were hepatitis B e antigen positive. Mean hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (group A). Thirteen patients died and three patients received liver transplantation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferase, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis and renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sustained in four patients.


CONCLUSIONS
Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e antigen seroconversion was less durable in this subgroup of patients and long-term therapy may be required.
Tsang
S W
SW
Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, New Territories, Hong Kong, China. swctsang@netvigator.com
Chan
H L
HL
Leung
N W
NW
Chau
T N
TN
Lai
S T
ST
Chan
F K
FK
Sung
J J
JJ
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006513:Hepatitis B e Antigens / Q000032:analysis* / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology*; D008099:Liver / Q000201:enzymology / Q000473:pathology; D017093:Liver Failure / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology*; D016896:Treatment Outcome
D006513:Hepatitis B e Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine