Clinical Course of Lamivudine Monotherapy in Patients with Decompensated Cirrhosis due to HBeAg negative chronic HBV infection

• Published in: The American journal of gastroenterology Vol. 99; no. 1; pp. 57 - 63
• Main Authors: MANOLAKOPOULOS, Spilios, KARATAPANIS, Stylianos, AVGERINOS, Alec, ELEFSINIOTIS, Jiannis, MATHOU, Nicoletta, VLACHOGIANNAKOS, Jiannis, ILIADOU, Elissabet, KOUGIOUMTZAN, Anastasios, ECONOMOU, Michalis, TRIANTOS, Christos, TZOURMAKLIOTIS, Dimitrios
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.01.2004; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Biological and medical sciences; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B e Antigens - analysis; Hepatitis B virus; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; Human viral diseases; Humans; Infectious diseases; Lamivudine - therapeutic use; Liver - physiopathology; Liver Cirrhosis - drug therapy; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Liver Cirrhosis - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Reverse Transcriptase Inhibitors - therapeutic use; Survival Rate; Treatment Outcome; Viral diseases; Viral hepatitis; Human; RNA-directed DNA polymerase; Enzyme; Transferases; Enzyme inhibitor; Hepatic disease; Lamivudine; Infection; Viral hepatitis B; Cirrhosis; Nucleotidyltransferases; Chronic; Viral disease; Dideoxynucleoside; Reverse transcriptase inhibitor; Gastroenterology; Digestive diseases; Nucleosidic analog; Pyrimidine nucleoside
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1046/j.1572-0241.2003.04021.x

We have evaluated the efficacy of long-term lamivudine monotherapy in patients with decompensated HBeAg-negative/HBV-DNA positive cirrhosis. We analyzed the clinical course and outcome of lamivudine treatment in 30 consecutive cirrhotics and compared with 30 HBV untreated historical HBeAg-negative controls matched for age and gender. Significant clinical improvement, defined as a reduction of at least two points in Child-Pugh score was observed in 23 of the 30 treated patients (76.6%) versus none of the 30 patients in the control group (p < 0.0001) after a mean follow-up of 20.6 +/- 12.1(+/-SD) months. There were 10 deaths in the treated group versus 24 in the control group (p= 0.07). Liver-related deaths occurred in five of the eight patients soon after the development of biochemical breakthrough. Patients with clinical improvement had better survival than patients with no improvement (p= 0.04) or those who developed biochemical breakthrough due to YMDD mutants (p= 0.001). Lamivudine significantly improves liver function in HBeAg-negative decompensated cirrhosis. However, the development of the biochemical breakthrough due to YMDD mutants is associated with fatal outcome.