Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension

Background/Aims: Lamivudine improves liver histology in patients with chronic hepatitis B (CHB), but its effects on portal pressure remain unknown. We evaluated the effect of lamivudine monotherapy on hepatic venous pressure gradient (HVPG) in CHB-related cirrhosis with significant portal hypertension. Methods: We studied 19 patients with cirrhosis due to HBeAg-negative CHB and HVPG >= 10 mm Hg treated with oral lamivudine (100 mg daily). Liver biochemistry, Child-Pugh and MELD score were determined every 3 months, alpha-fetoprotein and HBV DNA every 6 months and HVPG at baseline and at 12 months after lamivudine initiation. Diuretics, beta-blockers, antibiotics and/or endoscopic therapy were used for routine indications. Results: At 12 months, a significant reduction was observed in ALT (p = 0.001), HBV DNA (p = 0.002), Child-Pugh (p = 0.012) and MELD score (p = 0.006). Four patients developed virological breakthrough during treatment. At 12 months, HVPG decreased in all but one patient [baseline: 14.4 +/- 3.9 and 12 months: 12.4 +/- 3.3 mm Hg (p = 0.007)]. HVPG decreased >20% or below the 12 mm Hg threshold in 10 of 13 patients with baseline HVPG >= 12 mm Hg. HVPG increased in a patient with hepatic flare after virological breakthrough. Conclusion: In conclusion, in patients with cirrhosis due to HBeAg-negative CHB, lamivudine monotherapy reduces HVPG, especially when virological suppression and biochemical remission is achieved. (C) 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.