Hepatitis B Virus DNA Suppression with Entecavir Therapy in a HBeAg-Negative Decompensated Chronic HBV

Abstract

Entecavir has not been approved for the treatment of chronic hepatitis B (HBV)-related decompensated cirrhosis. Therefore, we report the first case of successful outcome of decompensated chronic HBV-related cirrhosis with entecavir therapy. Case: A 58 year old Arab-American male with HBeAg-negative chronic HBV-related cirrhosis presented with ascites, variceal bleeding, hepatic encephalopathy, elevated transaminases and high HBV DNA level (Table). He was treated with entecavir 0.5 mg daily and had a significant reduction in HBV DNA, but maintained high bilirubin and INR with ascites. Since his clinical status did not improve (MELD Score 40) despite having significant reduction in HBV DNA with entecavir therapy, he underwent cadaveric liver transplantation. He has complicated postoperative course including intra-abdominal bleeding and a repair of anastomotic bile duct. However, with the continued use of entecavir and hepatitis B immunoglobin including other immunosuppresive agents after transplantation he maintained non-detectable HBV DNA with normalization of transaminases after 12 weeks post-transplantation.TableDiscussion: There is no data in literature on entecavir for the treatment of chronic HBV-related decompensated cirrhosis. However, entecavir is much more effective compared to lamivudine for the treatment of chronic HBV with well compensated liver disease and has no drug-related resistance after 1 year of therapy among naive patients. To the best of our knowledge, this is the first report to show the effectiveness of entecavir in suppressing HBV DNA in a chronic HBV-related decompensated cirrhotic patient with successful post-transplant outcome without having any drug-related complication. It appears that entecavir is safe to use among patients with decompensated HBV-related cirrhosis. Hence, we recommend a large randomized clinical trial of entecavir among chronic HBV patients with decompensated cirrhosis.