title: Use of nucleoside (tide) analogues in patients with hepatitis B-related acute liver failure.
abstract: OBJECTIVE
  The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF.
  
  
  METHODS
  The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction.
  
  
  RESULTS
  The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival.
  
  
  CONCLUSIONS
  Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8887, USA.
authors.forename: Doan Y
authors.initials: DY
authors.lastname: Dao
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Seremba
authors.forename: Veeral
authors.initials: V
authors.lastname: Ajmera
authors.forename: Corron
authors.initials: C
authors.lastname: Sanders
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000737:chemistry* / Q000494:pharmacology*; D001663:Bilirubin / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000737:chemistry* / Q000494:pharmacology*; D011517:Prothrombin Time / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D009705:Nucleosides; D000637:Transaminases; D001663:Bilirubin