Lamivudine therapy of hepatitis B virus-related liver disease: cirrhosis, posttransplantation recurrence, and de novo infection

Bárcena, Rafael; Domínguez-Antonaya, Mercedes; López-Sanromán, Antonio; Martínez-Turnes, Alfonso; Urmán, Jesús; Campo, Salvatore; Moreno, N

doi:10.1016/s0041-1345(99)00416-9

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…WBC, neutrophil percentage, CRP, PCT and endotoxin are the most common and sensitive indexes used to measure infection and the most intuitive indexes for infection extent of blood routine at present, and their elevated degree is directly proportional to disease degree of inflammation ( 19 ). The present study also verified that the above indexes of the hepatitis B cirrhosis patients complicated with infection were higher than those of the hepatitis B cirrhosis patients without infection.…”

Section: Discussionmentioning

confidence: 99%

Correlation between cortisol levels and concurrent infection for hepatitis B cirrhosis patients and countermeasure analysis

Zhang

Wang

et al. 2018

Exp Ther Med

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The study assessed the correlation between cortisol (COR) levels and concurrent infection for the patients with hepatitis B cirrhosis for corresponding countermeasure analysis. In total, 86 patients with hepatitis B cirrhosis (non-infection group) and 32 patients with hepatitis B cirrhosis complicated with infection (infection group) who were diagnosed and treated in the Beijing YouAn Hospital from March 2014 to March 2017 were selected. The fasting venous blood of all the patients was drawn to detect COR, cortisol binding globulin (CBG), blood routine indexes, C-reactive protein (CRP), procalcitonin (PCT), endotoxin and other indicators. The relative expression of CBG mRNA was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). The differences and correlation of COR levels between the infection and non-infection groups were compared and analyzed. The concentrations of COR and CBG were decreased with the increase of Child-Pugh grade, and the difference was statistically significant (P<0.05). COR, CBG and free cortisol (FC) concentrations with the same Child-Pugh grade in the non-infection group were higher than those in the infection group (P<0.05). COR, CBG and FC concentrations of abdominal infection complicated with sepsis or abdominal infection complicated with pulmonary infection were lower than those of simple abdominal infection (P<0.05). The relative expression of CBG mRNA was detected by RT-qPCR, which also showed that: for Child-Pugh grade, grade A > grade B > grade C (P<0.05), non-infection group > infection group (P<0.05), abdominal infection + sepsis group and abdominal infection + pulmonary infection group were lower than the simple abdominal infection group (P<0.05). The values of white blood cells (WBC), neutrophils, CRP, PCT and endotoxin in the infection group were higher than those in the non-infection group, and the differences were statistically significant (P<0.05). COR, CGB and FC were negatively correlated with inflammatory indexes such as WBC, neutrophils, CRP, PCT and endotoxin. The r value of COR and FC in the non-infection group was 0.678, while that of OR and FC in the infection group was 0.787. COR was positively correlated with FC before and after infection. The results of the study show that the cortisol levels of patients with hepatitis B cirrhosis are significantly correlated with whether infected or not, levels of disease condition and infection types, and can be used as sensitive indicators of hepatitis B cirrhosis infection.

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Section: Discussionmentioning

confidence: 99%

Correlation between cortisol levels and concurrent infection for hepatitis B cirrhosis patients and countermeasure analysis

Zhang

Wang

et al. 2018

Exp Ther Med

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“…Eight patients went on to transplantation, whereas 3 patients improved to allow medical and/or surgical management. 15 Time to transplantation was not reported. Markowitz et al 16 evaluated the efficacy of a prophylactic combination of lamivudine and HBIG for HBV recurrence in 14 subjects posttransplantation.…”

Section: Discussionmentioning

confidence: 99%

Clinical improvement in patients with decompensated liver disease caused by hepatitis B after treatment with lamivudine

2000

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Lamivudine is effective in inhibiting hepatitis B virus (HBV) replication, and its clinical use in patients with chronic hepatitis B is associated with improvements in serum aminotransferase levels and liver histopathologic characteristics. Few data are available on its use in patients with advanced liver disease. We report on the outcomes of 5 patients with hepatic decompensation caused by chronic hepatitis B treated long term with lamivudine. All patients were adult white men seropositive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) before therapy. All 5 patients had biopsy-proven cirrhosis with clinical and biochemical evidence of hepatic decompensation. Two patients had Child's class C cirrhosis; 2 patients, class B; and 1 patient, class A (although this patient had persistent portasystemic encephalopathy and developed variceal bleeding). HBV DNA became undetectable in all patients and remained so throughout the study. Interferon-␣ has been the mainstay of therapy for chronic hepatitis B. Published clinical data on interferon for treatment of chronic HBV suggests nearly a 33% response, gauged by hepatitis B e antigen (HBeAg) clearance. 3 Most of these data are reflective of patients with compensated liver disease compared with those with advanced stages and decompensation, who appear to have unfavorable responses and severe complications. HBV-related end-stage liver disease remains a controversial indication for transplantation because of the high incidence of posttransplantation recurrence, estimated at 60% to 90% of all cases, and inferior survival rates compared with other forms of chronic liver failure. 4 Trials using interferon have been discouraging in patients with advanced disease, and the success seen with long-term perioperative and postoperative hyperimmune B immunoglobulin (HBIG) has met with high costs and limited supplies. [5][6][7] Lamivudine, an (-) enantiomer of 3-thiacytidine with potent antiviral inhibitory effects against HBV, 8 markedly reduced serum HBV DNA levels and improved biochemical and histological parameters in patients with chronic HBV infection. 8,9 However, few data exist evaluating long-term lamivudine therapy in patients with decompensated liver disease caused by HBV for the effect on serum markers of HBV replication, liver function, and the safety profile.Recently, a series of 35 patients with decompensated cirrhosis caused by HBV were treated with lamivudine, and long-term biochemical and clinical outcomes were evaluated. 10 Here, we report and compare our findings on the biochemical and clinical outcomes of a small number of patients with decompensated cirrhosis treated with lamivudine.

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“…Further reports have demonstrated that liver disease activity could be controlled after transplantation with either of these 2 agents, with improved serum levels of liver enzymes and improved liver synthetic tests; in some cases, both liver enzymes and liver function tests returned to normal 13. When this occurs before LT, it may eliminate the need for transplantation; after transplantation, it may prevent graft loss and death or the need for a second transplant 14–23…”

Section: Treatment Of Hbv Infection Before Lt and Its Impact On Post‐mentioning

confidence: 99%

Hepatitis B in liver transplant recipients

Gish

McCashland

2006

Liver Transpl

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Key Concepts: 1. The use of low-dose immunosuppressive therapy along with pre-and posttransplantation nucleos(t)ide therapy and posttransplantation hepatitis B immunoglobulin (HBIG) has yielded marked improvements in survival. 2. Lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), tenofovir (Viread), emtricitabine (Emtriva), and the combination drugs tenofovir ϩ emtricitabine (Truvada) and abacavir ϩ lamivudine (Epzicom) are effective nucleos(t)ide antiviral agents that, in some cases, may help reverse liver disease sufficiently to avoid transplant. 3. In posttransplantation patients, virus suppression with some combination of HBIG and the nucleos(t)ide agents may prevent graft loss and death or the need for a second transplant. 4. In both the pre-and posttransplantation setting, the goal of hepatitis B virus management is complete virus suppression. 5. The use of low-dose intramuscular HBIG is evolving, with studies showing that dosing and cost can be reduced by 50-300% with a customized approach. 6. Elimination of HBIG from the treatment paradigm is currently under evaluation and may be possible with the use of newer medications that have no or low resistance rates. 7. Although there is growing evidence that some types of combination therapy may decrease the chance that drug resistance will develop and increase the likelihood of long-term success in preventing graft loss and death, additional research will be required to determine which combinations will work well in the long term, and which will not. Liver In 2001, the patient sought care from a gastroenterologist for increased abdominal distension and increasing fatigue. An ultrasound of the abdomen showed a cirrhotic liver, with a large amount of ascites. An esophagogastroduodenoscopy revealed grade 2 varices with portal hypertensive gastropathy. His renal function was normal. Therapy with the following was initiated at the time of his medical evaluation: lamivudine (100 mg daily), Aldactone (100 mg daily), Lasix (40 mg daily), and propranolol (20 mg twice daily).After 1 year of therapy, laboratory values were as follows: AST 101 U/L, ALT 56 U/L, bilirubin 2.4 mg/dL, albumin 2.9 g/dL, and international normalized ratio of prothrombin time 1.4. HBV serologies were unchanged. He was lost to follow-up for the next 2 years, but he stated that he continued lamivudine therapy.In June 2003, he was transferred to a transplant center as a result of increased lethargy, encephalopathy (grade 2), and worsening ascites. Physical examination revealed mild confusion. Vital signs were as follows: heart rate 120 beats/min, blood pressure 100/65 mm Hg, and temperature 38.0°C. He had scleral icterus and severe muscle wasting. Abdominal examination showed moderate tense ascites. Table 1 lists laboratory data.The patient's Model for End-Stage Liver Disease score was 34. Because paracentesis revealed ascitic fluid white count of 6.3 ϫ 10 3 / L with 72% segmented neutrophils, ceftriaxone and albumin infusions were started. Ultrasonography showed a cirrhotic liver ...

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Lamivudine therapy of hepatitis B virus-related liver disease: cirrhosis, posttransplantation recurrence, and de novo infection

Cited by 8 publications

References 11 publications

Correlation between cortisol levels and concurrent infection for hepatitis B cirrhosis patients and countermeasure analysis

Correlation between cortisol levels and concurrent infection for hepatitis B cirrhosis patients and countermeasure analysis

Clinical improvement in patients with decompensated liver disease caused by hepatitis B after treatment with lamivudine

Hepatitis B in liver transplant recipients

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