The effect of lamivudine therapy in hepatic decompensation during acute exacerbation of chronic hepatitis B

Background/Aims: Severe acute exacerbation (AE) of chronic hepatitis B (CHB) can lead to hepatic decompensation and death. The aim of this study was to investigate the effect of lamivudine therapy in hepatic decompensation during such AEs. Methods: In a 10-month period, a total of 60 consecutive AE patients with jaundice and prolonged prothrombin time over 3 s were treated with lamivudine 150 mg daily. As a historical control, another 31 CHB patients with AE resulting in hepatic decompensation hospitalized in an immediate past 6-month period were enrolled for comparison. Results: Patients in both groups were comparable in clinical and biochemical features. After a median treatment period of 6 weeks (range 148 weeks), all of the 25 patients with pretherapy bilirubin level <20 mg/dl in the treatment group survived, while five (25%) of 20 patients in the control group died (P = 0.013; odds ratios, 2.667; 95% confidence interval, 1.787-3.979). However, the mortality rate was similar in patients with pretherapy bilirubin level greater than or equal to20 mg/dl in both groups. Conclusions: These results suggest that lamivudine may prevent fatality in CHB patients with hepatic decompensation if therapy starts early enough or before serum bilirubin level rise over 20 mg/dl, but helps little if serum level already rised over that level. (C) 2002 Published by Elsevier Science B.V. on behalf of the European Association for the Study of the Liver.