Lamivudine treatment for acute exacerbation of hepatitis B in patients undergoing immunosuppressive therapy

Abstract

Lamivudine was administrated to six patients with acute exacerbation of hepatitis B who were undergoing immunosuppressive therapy. All patients had chronic hepatitis B and were receiving immunosuppressive therapy for other primary diseases (hematologic malignancies, collagen diseases, renal transplantation) when the hepatitis flared up. Only one patient tested positive for the hepatitis B virus e (HBe) antigen. All patients had normal ALT levels and were anti-HBe-positive before immunosuppressive therapy. The patients were treated with 150 mg of lamivudine daily. Lamivudine was well tolerated and showed no effect on the primary disease. In all patients, hepatitis B virus (HBV) DNA levels decreased in response to lamivudine administration. Four patients recovered from exacerbation, but two patients died from complications. Molecular analysis revealed that, regardless of whether patients had the wild HBV genotype or mutations within the core promoter or precore HBV regions, the effectiveness of lamivudine therapy was the same. These results demonstrated that lamivudine is very effective for treating acute exacerbation of chronic hepatitis B that occurs while a patient is undergoing immunosuppressive therapy, regardless of the phenotype of the virus.