Entecavir Therapy for Adefovir-Resistant Hepatitis B Virus Infection in Kidney and Liver Allograft Recipients

Abstract

The aim of our study was to assess the efficacy and safety of entecavir in kidney- and liver-transplant recipients with chronic hepatitis B virus (HBV) infection. Ten male transplant patients with chronic HBV infection (eight kidney- and two liver-transplant patients), who have become adefovir (n=9) or lamivudine-resistant (n=1) were given entecavir at 0.5 to 1 mg/d. All patients were HBs Ag positive: six were HBe Ag(-)/HBe Ab(+), and four were HBe Ag(+)/HBe Ab(-). After a median follow-up of 16.5 months, entecavir therapy was associated with a significant decrease in HBV DNA viral load, that is, 3.86 (2.71-6.46) log10 copies/mL at baseline down to 2.94 (2.15-4) log10 copies/mL at last follow-up (P=0.004). Rate of HBV DNA clearance was 50% in both HBeAg(+) and HBeAg(-) patients. There were no significant changes in renal function or hematological parameters. This study demonstrates that entecavir therapy is safe and efficient in HBV(+) organ-transplant patients.

Antiviral treatment for chronic hepatitis B in renal transplant patients

“…Other studies reported results with ETV in cohorts including both naïve and LAM-R patients, unfortunately with limited number of patient [42][43][44][45] .…”

“…Treatment with ETV resulted in an appreciable drop in HBV DNA levels and a 50% HBV undetectability in both HBeAg positive and HBeAg negative patients after 16.5 mo of treatment without significant changes in glomerular filtration rate [42] . In our small experience we reported ETV use in 11 patients with several chronic renal diseases: 1 with stage 4 CKD, 7 in dialysis, and 3 RT recipients [43,44] .…”

“…Experience regarding the use of ETV in RT recipients who had developed LAM-or ADV-resistance had been examined in a small study with 10 solid organ transplant recipients (8 kidney allograft recipients) [42] . Treatment with ETV resulted in an appreciable drop in HBV DNA levels and a 50% HBV undetectability in both HBeAg positive and HBeAg negative patients after 16.5 mo of treatment without significant changes in glomerular filtration rate [42] .…”

Treatment of special populations with chronic hepatitis B infection

“…Most of the NUCs (LAM, adefovir and ETV) have been used in HBsAg + patients with chronic renal failure, on dialysis or after renal transplantation, in doses modified according to creatinine clearance [106][107][108]. Following renal transplantation, there are reports of worsening of renal graft function with adefovir; ETV may therefore be the drug of choice for this category of patients.…”

Considerations for the long-term treatment of chronic hepatitis B with nucleos(t)ide analogs

“…Guidelines recommend prophylactic NA therapy during immunosuppressive-/chemotherapy for all patients who are HBsAg(+) [1][2][3]. There are limited data on the use of entecavir or tenofovir in this setting [38][39][40][41]; however, these agents are preferable to lamivudine because of the reduced risk of resistance development [1,3].…”