title: Prediction of prognosis to lamivudine in patients with spontaneous reactivation of hepatitis B virus-related acute-on-chronic liver failure: using virologic response at week 4.
abstract: OBJECTIVE
  Current results had demonstrated lamivudine (LAM) contributed to improve liver function and short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF), but data concerning the outcome of long-term prognosis are limited. Our objective was to explore the prediction value of early viral response for prognosis and LAM resistance in ACLF patients with lamivudine treatment within 96weeks.
  
  
  METHODS
  One hundred and forty consecutive subjects were recruited, 76 patients were treated with LAM and supportive treatment (LAM group) and 64 patients only received supportive treatment (non-NAs group). All the patients were followed up until death or 96weeks. The primary end point was overall survival rate at 96weeks, as well as the relationship between the virologic response at weeks 4 or 12 and prognosis and resistance at 96weeks.
  
  
  RESULTS
  At 96weeks, the cumulative survival was higher in the LAM group than that in the non-NA group (43/76 (56.58%) vs 9/64 (14.06%), respectively, p=0.000). The survival rate of patients achieved complete viral response (CVR) at week 4 was higher than that of those with partial virologic response (PVR) during the 96-week follow-up (27/29 [93.10%] vs 16/45 [35.56%], p=0.000). In CVR patients, there was a significant improvement in model for end-stage liver failure (MELD) scores compared to PVR. Logistic recurrence indicated that both 4-week CVR and MELD scores were an independent predictor of the 96-week survival. Twelve patients developed LAM resistance (22.22%); all of them came from the PVR at 4weeks.
  
  
  CONCLUSIONS
  LAM can significantly improve the long-term survival rate, and 4weeks CVR can predict the long-term clinical outcome and LAM-resistant in patients with HBV-related ACLF.
authors.affiliation: Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China; Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiang-Hui
authors.affiliation: Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; People's Hospital of District of YuBei, Chongqing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Lang
authors.affiliation: Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China; Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Yan
authors.affiliation: Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China; Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China; Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: sxf7776@163.com.
authors.forename: Shi
authors.initials: S
authors.lastname: Xiao-Feng
authors.affiliation: Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China; Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Ren
authors.initials: R
authors.lastname: Hong
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine
keywords: Antiviral drug resistance; Hepatitis B virus; Lamivudine; Liver failure; Treatment outcome