Entecavir treatment for chronic hepatitis B infection in end‐stage renal disease and kidney transplantation

Abstract

BACKGROUND The prevalence of chronic hepatitis B virus (HBV) infection is high in patients with end‐stage renal disease and in kidney transplant recipients, and there is little experience with treatment using the newer antiviral drugs. The aim of this study was to assess the efficacy and safety of entecavir in HBV infection in this difficult‐to‐treat population. METHODS Eleven male patients—1 with stage 4 chronic kidney disease, 7 undergoing hemodialysis, and 3 kidney transplant recipients‐were included in the study evaluation. Six were treatment naïve, and 5 were lamivudine resistant. Entecavir was administered at a dose of 0.1–1 mg qd according to the patients' renal function. All were HBsAg positive: 9 were HBeAg (+)/antiHBe (−), and the remaining 2 were HBeAg (−)/antiHBe (+). RESULTS After a median treatment of 2 ± 0.86 years, entecavir therapy was associated with a significant decrease in HBV DNA viral load: it was 6.84 ± 1.45 log10 UI/mL (range 5.21–9.04) at baseline and at the time of evaluation had dropped to 1.73 ± 2.11 log10 UI/mL (range <0.78–4.72). The rate of HBV DNA clearance was 54.5% (n = 6). The rate of anti–HBe seroconversion was 77.7% (7/9 HBeAg‐positive patients). The rate of anti‐HBs seroconversion was 9.1% (1/11 patients). There were no significant changes in renal function or hematological parameters. CONCLUSIONS This small study demonstrates that entecavir therapy is safe and efficient in HBV‐positive patients with varying degrees of renal dysfunction.

Review article: nucleos(t)ide analogues in patients with chronic hepatitis B virus infection and chronic kidney disease

“…There are very few clinical data on the use of NAs in patients undergoing HD. In particular, there are 5 reports with a total of 38 patients treated with lamivudine for 10–14 months (4–16 patients in each report), 3 reports with a total of 7 patients treated with adefovir for 15–24 months (two case reports and one report with 5 patients), one report with 7 patients treated with entecavir for 14 months and one report with an HIV and HBV co‐infected patient treated with tenofovir for 6 months . Given that kidneys are seriously damaged in patients undergoing HD, renal safety may not affect the choice of NA in this subgroup of CHB patients.…”

Antiviral treatment for chronic hepatitis B in renal transplant patients

“…HBV DNA was cleared in 54.5% (n = 6); 77.7% of HBeAg-positive patients (7/9) seroconverted to antiHBe positive; and only one patient (9.1%) showed antiHBs seroconversion. There were no significant changes in renal or hematological biochemical parameters [43,44] . In the most recent report, twenty-one RT patients (10 treatment naïve, 11 with LAM resistance) were treated with ETV for 34.7 ± 22.9 mo (range 6-75 mo) [45] .…”

“…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] . HBV DNA was cleared in 54.5% (n = 6); 77.7% of HBeAg-positive patients (7/9) seroconverted to antiHBe positive; and only one patient (9.1%) showed antiHBs seroconversion.…”

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

“…Pegile interferon (PegIFN) kullanımı yan etki sıklığını azaltmamıştır. LAM ve ETV etkili ve güvenlidir (27,28). LdT ile ilgili veri yoktur.…”