Hepatitis B-associated acute liver failure: immediate treatment with entecavir inhibits hepatitis B virus replication and potentially its sequelae.
BACKGROUND
Acute hepatitis B virus (HBV) infection is followed by high viral replication rates leading to hepatocyte death and ultimately, in some cases, to acute liver failure (ALF) necessitating liver transplantation. Thus, the objective of treating HBV-induced ALF is to eliminate or significantly suppress HBV replication.


RESULTS
This prospective study (02/2008-02/2009) included 6 patients (1 female and 5 males, median age 35.5 years). HBV DNA and hepatitis B surface antigen (HBsAg) levels were detected, and hepatocyte death was quantified in patients' sera by (a) M65 ELISA and (b) M30 ELISA. All patients received entecavir treatment at 1 mg daily within 1-18 days after admission. Upon treatment, pathologic parameters rapidly decreased and returned to normal values or trace amounts (HBV DNA) within 3 months in all of the cases. A seroconversion to anti-HBsAg was achieved in 5 out of 6 patients; one patient with late onset of treatment did not seroconvert. M65 and the difference of M65-M30 as a marker for cell necrosis dropped significantly within 1 week of treatment.


CONCLUSIONS
This preliminary series of 6 patients reveals that immediate treatment of HBV-induced ALF with entecavir is well tolerated and beneficially affects the course of the disease.
Jochum
Christoph
C
Division of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
Gieseler
Robert K
RK
Gawlista
Isabella
I
Fiedler
A
A
Manka
Paul
P
Saner
Fuat H
FH
Roggendorf
Michael
M
Gerken
Guido
G
Canbay
Ali
A
D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016923:Cell Death / Q000187:drug effects; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000188:drug therapy / Q000821:virology*; D008297:Male; D011446:Prospective Studies; D014779:Virus Replication / Q000187:drug effects; D055815:Young Adult
D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; C413685:entecavir; D006147:Guanine