The effect of lamivudine therapy in hepatic decompensation during acute exacerbation of chronic hepatitis B

Abstract

Abstract Background/Aims : Severe acute exacerbation (AE) of chronic hepatitis B (CHB) can lead to hepatic decompensation and death. The aim of this study was to investigate the effect of lamivudine therapy in hepatic decompensation during such AEs. Methods : In a 10-month period, a total of 60 consecutive AE patients with jaundice and prolonged prothrombin time over 3s were treated with lamivudine 150mg daily. As a historical control, another 31 CHB patients with AE resulting in hepatic decompensation hospitalized in an immediate past 6-month period were enrolled for comparison. Results : Patients in both groups were comparable in clinical and biochemical features. After a median treatment period of 6 weeks (range 1–48 weeks), all of the 25 patients with pretherapy bilirubin level P =0.013; odds ratios, 2.667; 95% confidence interval, 1.787–3.979). However, the mortality rate was similar in patients with pretherapy bilirubin level ≥20mg/dl in both groups. Conclusions : These results suggest that lamivudine may prevent fatality in CHB patients with hepatic decompensation if therapy starts early enough or before serum bilirubin level rise over 20mg/dl, but helps little if serum level already rised over that level.