[Lamivudine therapy in patients with severe acute hepatitis B]

Fulminant hepatitis develops in 1 % of patients with acute hepatitis B. Lamivudine therapy in patients with severe acute hepatitis B probably reduces their risk of fulminant hepatitis but experience with this type of treatment is still limited.

Between 1999 and 2006, 17 immunocompetent patients (12 women, 5 men, age 17-83 years) with severe acute hepatitis B were treated with lamivudine. Prior to treatment, all patients had their total bilirubin values above 220 micromol/l (more than 13 mg/dl). In 9 patients, the marked increase of bilirubin levels was accompanied by aminotransferase level decrease. Sixteen patients received lamivudine at a dose of 100 mg per day; one patient was given 150 mg daily. In 12 patients, concurrent corticosteroid therapy was administered.

One patient developed fulminant hepatitis B and underwent successful urgent liver transplantation 5 days after the lamivudine therapy was initiated. Sixteen patients responded well to the treatment and their biochemical parameters improved rapidly. Within 3-7 months, the HBsAg was undetectable in 14 out of 15 investigated patients. Protective anti-HBs antibodies developed in 11 of them in 3-21 months. The lamivudine therapy was terminated in 12 patients and it continued for more than 1 year in 3 patients only. Four patients continue to receive lamivudine but the therapy still has not exceeded 9 months. The corticosteroid therapy was short-term; it was longer than one month in 1 of 12 patients.

Early treatment with lamivudine alone or with corticosteroids probably decreases the risk of progression to fulminant hepatitis in patients with severe acute hepatitis B.