Acute hepatitis B: is antiviral therapy necessary? Two illustrative case reports

Introduction: The efficiacy of Entecavir and Adefovir for treatment of acute hepatitis B is not known. History: Two women with severe acute hepatitis B (HB) complained about a skin rash as well as jaundice, nonspecific epigastric and joint discomfort. Laboratory findings: Both patients had severe liver cell damage caused by the HB virus. Transaminases were elevated up to 150 times the normal range (normal: ALT up to 34 U/l, AST up to 31 U/l) and bilirubin was raised up to 35 times above normal (17 mu mol/l). Liver synthesis, as measured by the Quick time test, was already impaired. High titers of HBs-antigen and HBV-DNA were detected. Treatment and course: Both patients were immediately admitted for antiviral therapy with lamivudine, in view of the prolonged prothrombin time. But there was no evidence of adequate recovery of liver function. Improvement followed after switching the antiviral therapy to entecavir or to an add-on with adefovir, respectively. Conclusion: Recently available nucleos(t)ide analogs, such as entecavir and adefovir, seem to be efficacious in acute hepatitis B therapy when lamivudine has failed. When prothrombin time is substantially prolonged, antiviral therapy is recommended. However, there is no consensus on antiviral therapy of acute hepatitis B in general, because data from large studies are still lacking. The findings described here suggest that such patients with acute hepatitis B should be treated within the German GAHB study (German acute hepatitis B study: www.gahb.de).