Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension.
OBJECTIVE
Lamivudine improves liver histology in patients with chronic hepatitis B (CHB), but its effects on portal pressure remain unknown. We evaluated the effect of lamivudine monotherapy on hepatic venous pressure gradient (HVPG) in CHB-related cirrhosis with significant portal hypertension.


METHODS
We studied 19 patients with cirrhosis due to HBeAg-negative CHB and HVPG >or=10 mm Hg treated with oral lamivudine (100mg daily). Liver biochemistry, Child-Pugh and MELD score were determined every 3 months, alpha-fetoprotein and HBV DNA every 6 months and HVPG at baseline and at 12 months after lamivudine initiation. Diuretics, beta-blockers, antibiotics and/or endoscopic therapy were used for routine indications.


RESULTS
At 12 months, a significant reduction was observed in ALT (p=0.001), HBV DNA (p=0.002), Child-Pugh (p=0.012) and MELD score (p=0.006). Four patients developed virological breakthrough during treatment. At 12 months, HVPG decreased in all but one patient [baseline: 14.4+/-3.9 and 12 months: 12.4+/-3.3 mm Hg (p=0.007)]. HVPG decreased >20% or below the 12 mm Hg threshold in 10 of 13 patients with baseline HVPG >or=12 mm Hg. HVPG increased in a patient with hepatic flare after virological breakthrough.


CONCLUSIONS
In conclusion, in patients with cirrhosis due to HBeAg-negative CHB, lamivudine monotherapy reduces HVPG, especially when virological suppression and biochemical remission is achieved.
Manolakopoulos
Spilios
S
Department of Gastroenterology, Polyclinic General Hospital, Athens, Greece. spilios1@otenet.gr
Triantos
Christos
C
Theodoropoulos
Jiannis
J
Vlachogiannakos
Jiannis
J
Kougioumtzan
Anastasios
A
Papatheodoridis
George
G
Tzourmakliotis
Dimitrios
D
Karamanolis
Dimitrios
D
Burroughs
Andrew K
AK
Archimandritis
Athanasios
A
Raptis
Sotirios
S
Avgerinos
Alec
A
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000378:metabolism*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D019259:Lamivudine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D008099:Liver / Q000378:metabolism; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects* / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D019259:Lamivudine; D000410:Alanine Transaminase