title: Lamivudine treatment for hepatitis B in dialysis population : case reports and literature review.
abstract: It is well known that chronic hepatitis B plays a detrimental role on survival in patients on long-term dialysis and after kidney transplantation. The advent of nucleos(t)ide analogues offers the opportunity to change the natural history of hepatitis B in patients with chronic kidney disease. We report our experience on lamivudine use in two patients with HBV-related liver disease on long-term dialysis. At the beginning, both the patients were HBsAg positive and HBeAg positive with high viral load; after long-term lamivudine therapy, clearance of HBV viremia from serum was observed in both. Raised aminotransferase levels fell into the normal range and one patient experienced clearance of HBsAg by anti-HBV therapy. Tolerance to lamivudine was satisfactory and lamivudine resistance was not detected. Information on antiviral therapy with lamivudine in HBsAg positive patients on regular dialysis is extremely limited; we identified by an extensive review of the literature five studies with a total of 38 unique patients, most of them being renal transplant candidates. Lamivudine proved to be effective as the clearance of HBV viraemia from serum ranged between 56% and 100% ; the clearance of HBeAg from serum was less evident (between 37.5% and 100%). No significant side-effects due to lamivudine were observed and emergence of lamivudine-resistant strains was observed in two (5%) patients. Only a minority of patients experienced HBsAg loss (13%). We conclude that anti-HBV treatment with a nucleoside analogue such as lamivudine gives satisfactory results in some patients on long-term dialysis. Clinical trials are in progress to assess efficacy and safety of last-generation nucleos(t)ide analogues for anti-HBV therapy in dialysis population.
authors.affiliation: Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano. fabrizi@policlinico.mi.it
authors.forename: F
authors.initials: F
authors.lastname: Fabrizi
authors.affiliation: Nephrology Unit. Como University Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Mangano
authors.affiliation: Nephrology Unit, Monza University Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Stellato
authors.affiliation: Division of Hepatology, School of Medicine, University of Miami, USA.
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.affiliation: Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano.
authors.forename: P
authors.initials: P
authors.lastname: Messa
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D004279:DNA, Viral; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D006435:Renal Dialysis; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine