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

• Published in: Journal of hepatology Vol. 51; no. 3; pp. 468 - 474
• Main Authors: Manolakopoulos, Spilios, Triantos, Christos, Theodoropoulos, Jiannis, Vlachogiannakos, Jiannis, Kougioumtzan, Anastasios, Papatheodoridis, George, Tzourmakliotis, Dimitrios, Karamanolis, Dimitrios, Burroughs, Andrew K, Archimandritis, Athanasios, Raptis, Sotirios, Avgerinos, Alec
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.09.2009; Elsevier
• Subjects: Administration, Oral; Adult; Aged; Alanine Transaminase - metabolism; alpha-Fetoproteins - metabolism; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - pharmacology; Antiviral Agents - therapeutic use; Biological and medical sciences; Biomarkers; DNA, Viral - blood; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B DNA; Hepatitis B e Antigens - metabolism; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - immunology; Hepatitis B, Chronic - physiopathology; Human viral diseases; Humans; Hypertension, Portal - complications; Hypertension, Portal - drug therapy; Hypertension, Portal - physiopathology; Infectious diseases; Lamivudine; Lamivudine - administration & dosage; Lamivudine - pharmacology; Lamivudine - therapeutic use; Liver - metabolism; Liver Cirrhosis - drug therapy; Liver Cirrhosis - etiology; Liver Cirrhosis - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Portal pressure; Portal Pressure - drug effects; Portal Pressure - physiology; Prognosis; Prospective Studies; Treatment Outcome; Viral diseases; Viral hepatitis; hepatic venous pressure gradient; Prognosis; Hepatitis B DNA; ALT; wedged hepatic venous pressure; BBR; free hepatic venous pressure; virological breakthrough; biochemical breakthrough; FHVP; hepatocellular carcinoma; polymerase chain reaction; serum aspartate; chronic hepatitis B; SBP; AST; model for end-stage liver disease; WHVP; HVPG; VBR; HCC; Portal pressure; CP; Child-Pugh; MELD; alanine aminotransaminase; LAM; spontaneous bacterial peritonitis; CHB; PCR; lamivudine; Lamivudine; Antiretroviral agent; RNA-directed DNA polymerase; Portal circulation disease; Cardiovascular disease; Hepatic disease; Vascular disease; Viral hepatitis B; Reverse transcriptase inhibitor; Gastroenterology; Portal hypertension; Nucleoside analog; Antiviral; Pyrimidine nucleoside; Human; Enzyme; Transferases; Enzyme inhibitor; Infection; Cirrhosis; Nucleotidyltransferases; Treatment; Dideoxynucleoside; Viral disease; DNA; Digestive diseases; Portal vein
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2009.05.031

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.