title: The impact of oral antiviral therapy on long-term survival of hepatitis B surface antigen-positive patients on haemodialysis.
abstract: OBJECTIVE
  Hepatitis B (HBV) is an important cause of morbidity and mortality in end-stage renal disease patients. The effect of oral antiviral therapy on survival in this population is not known. We evaluated the impact of oral antivirals on survival of HBV-infected haemodialysis patients.
  
  
  METHODS
  This retrospective study included 52 HBsAg-positive haemodialysis patients and 156 non-infected haemodialysis controls. Criteria adopted for starting lamivudine were the 2001 American Association for the Study of Liver Diseases guidelines. Lamivudine was commenced in 21 (40.4%) patients, with median treatment duration of 58 months. The primary endpoint was transplant-free survival.
  
  
  RESULTS
  Survival of HBsAg-positive patients was equivalent to that of age- and sex-matched HBsAg-negative controls (39.1% vs 33.2% at 10 years, respectively; P=0.12). In treated patients, complete viral suppression was associated with improved survival (serial HBV DNA less than and equal to 2 log10 IU/mL, 90.9% vs HBV DNA >2 log10 IU/mL on at least one occasion, 74.1% at 5 years; P=0.049). Out of 20 deaths, three were liver-related.
  
  
  CONCLUSIONS
  Haemodialysis patients with chronic HBV, when given oral antiviral therapy if indicated, had equivalent long-term survival to that of non-infected controls. In those with active viral hepatitis, viral suppression was associated with reduced liver-related mortality.
authors.affiliation: South West Liver Unit, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, United Kingdom. mow001@aucklanduni.ac.nz.
authors.forename: Maggie M G
authors.initials: MM
authors.lastname: Ow
authors.forename: Janak R
authors.initials: JR
authors.lastname: de Zoysa
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gane
mesh_terms: D000284:Administration, Oral; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D017741:Survivors
chemical_list: D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine