Lamivudine Treatment for Fulminant Hepatic Failure

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JANUARY  2002 VIRAL HEPATITIS B- Lamivudine Treatment for Fulminant Hepatic Failure due to Acute Exacerbation of Chronic Hepatitis B Infection



S. W. C. Tsang (1), H. L. Y. Chan (1), N. W. Y. Leung (1), T. N. Chau (2), S. T. Lai (2), F. K. L. Chan (1), J. J. Y. Sung (1)

(1) Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, New Territories, Hong Kong,

(2) ChinaDivision of Gastroenterology, Department of Medicine, Princess Margaret Hospital, Lai Chi Kok, Hong Kong, China



Background: Exacerbation of chronic hepatitis B infection can lead to fulminant hepatic failure with a mortality of up to 90%.

Aim: To evaluate the efficacy of lamivudine in the treatment of this subgroup of patients.

Methods: Twenty-four patients with exacerbation of chronic hepatitis B infection and fulminant hepatic failure were treated with lamivudine, 100 mg daily. Hepatitis A, C, D and human immunodeficiency virus co-infections and hepatocellular carcinoma were excluded.

Results: The median age was 53 years (range, 24-77 years) with a male predominance of 20:4. Seventeen patients were hepatitis B e antigen positive. Mean hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (group A). Thirteen patients died and three patients received liver transplantation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferase, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis and renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sustained in four patients.

Conclusions: Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e antigen seroconversion was less durable in this subgroup of patients and long-term therapy may be required. (Alim. Pharm. Therap., 15, 11, 1737, 2001)

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Thank you! I  hope we can  read more works about HBV.