Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection

Background: Exacerbation of chronic hepatitis B infection can lead to fulmi nant hepatic failure with a mortality of up to 90%. Aim: To evaluate the efficacy of lamivudine in the treatment of this subgro up of patients. Methods: Twenty-four patients with exacerbation of chronic hepatitis B infe ction and fulminant hepatic failure were treated with lamivudine, 100 mg da ily. Hepatitis A, C, D and human immunodeficiency virus coinfections and he patocellular carcinoma were excluded. Results: The median age was 53 years (range, 24-77 years) with a male predo minance of 20:4. Seventeen patients were hepatitis B e antigen positive. Me an hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (gr oup A). Thirteen patients died and three patients received liver transplant ation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferas e, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis an d renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sust ained in four patients. Conclusions: Lamivudine may be useful in treating patients with fulminant h epatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e an tigen seroconversion was less durable in this subgroup of patients and long -term therapy may be required.