Lamivudin treatment in patients with acute severe hepatitis B
Abstract number: 1733_986
Mrazek J., Lochman I., Kloudova A., Roznovsky L., Orsagova I.
Objectives: Severe acute hepatitis B in immunocompetent patients may progress to fulminant hepatitis and death. Lamivudin has been approved for the treatment of chronic hepatitis B but experience with lamivudin treatment for acute severe hepatitis B is still limited.
Methods: In the period of 19992006 years, 15 immunocompetent patients (10 women, 5 men, age 1883 years) with severe acute hepatitis B were treated with lamivudin. Fourteen patients received lamivudin at a dose 100 mg per day, one patient 150 mg daily. Prior to treatment, all patients were positive for hepatitis B surface antigen (HBsAg) and IgM antibodies to hepatitis B core antigen; 12 patients were positive for hepatitis B e antigen (HBeAg); all patients had evidence of severe hepatocyte lysis; all patients had total bilirubin 230 micromole per litre or higher (above 14 mg per decilitre). Nine patients had rapid increase of total bilirubin and contemporary decrease of alanine aminotransferase level, which escalate risk of development of fulminant hepatitis B.
Results: Fourteen patients responded to treatment. Therapy induces a prompt clinical and biochemical response and was well tolerated in all cases. HBsAg disappearance was criterion for termination of lamivudin treatment. HBsAg was undetectable in 11 patients, and protective anti-HBs antibodies developed in 4 of them. Lamivudin was administered in these 11 patients for 413 months. Three patients still receive lamivudin, but the therapy is shorter than 6 months. The 12 patients who were HBeAg positive before treatment seroconverted within 2 months, and anti-HBe antibodies developed in 11 of them.
One patient with severe encephalopathy developed fulminant hepatitis B and underwent urgent liver transplantation 7 days after initiation of lamivudin treatment. Seven years after transplantation, the patient is without recurrence of hepatitis B and the treatment with lamivudin and hepatitis B immunoglobulin still continues.
Conclusion: Lamivudin induces a prompt clinical, biochemical and serological response in immunocompetent patients with severe acute hepatitis B. Timing of lamivudin administration is crucial, early lamivudin treatment of severe acute hepatitis B may prevent the progression to fulminant hepatitis.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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