Lamivudine treatment in patients with severely decompensated cirrhosis dueto replicating hepatitis B infection

Background/Aims: Lamivudine is highly effective in suppressing hepatitis B viral replication and hepatic necroinflammatory activity. The potential for recovery of hepatic decompensation in patients with chronic hepatitis B in fection treated with lamivudine has not been established. The aim of this s tudy was to evaluate the effectiveness of lamivudine treatment in severely decompensated cirrhosis due to chronic hepatitis B, Methods: Thirteen consecutive patients with chronic hepatitis B infection, Child's-Pugh-Turcotte (CPT) score of greater than or equal to 10 (median sc ore=11) and detectable circulating hepatitis B DNA (range 15 to 9634 pg/ml) were included and treated with lamivudine 150 mg once daily. Hepatitis B e nvelope antigen (HBeAg) was positive in 9 of 13 patients pre-treatment. Results: Two patients underwent liver transplantation at 4 and 6 weeks afte r starting lamivudine treatment. The remaining 11 patients were followed fo r a mean of 17.5 months without liver transplantation (range 3 to 39 months ), Significant improvement of liver function, defined as a decrease in CPT score of greater than or equal to 3, was observed in 9 of 13 patients (69%) , In five patients, CPT score improved to <7 and they were placed on the in active status (UNOS status 7) for liver transplantation. Hepatitis B DNA re mained negative in all except one patient who developed breakthrough viral replication 12 months after starting lamivudine treatment, while maintainin g stable liver function. Three of seven HBeAg-positive patients who did not undergo liver transplantation lost HBeAg during follow-up, but none had su stained seroconversion to hepatitis B e antibody. Conclusion: Lamivudine appears highly effective in reversing severe hepatic decompensation due to replicating hepatitis B infection.