Experience with lamivudine treatment for severe acute hepatitis B

Experience with lamivudine treatment for acute severe hepatitis B is limited. Fulminant hepatitis develops in 1% of immunocompetent patients with acute hepatitis B.

The aim of this study was to evaluate the efficacy of lamivudine in the treatment of severe acute hepatitis B (SAHB) in immunocompetent adult patients.

Between January 2006 and May 2013 at the Clinic for Infectious Diseases Banja Luka, 13 patients with SAHB were treated with lamivudine at a dose of 100 mg per day. All 13 patients fulfilled at least two of three default criteria: 1. hepatic encephalopathy; 2. total bilirubin greater than 210 μmol/L; and 3. severe coagulopathy (international normalized ratio--INR ≥1.5 or prothrombin time--PT <40%). The criteria were defined according to the experiences reported in the study of Schmilovitz-Weiss et al. "Lamivudine treatment for severe acute hepatitis B". Nine patients had a rapid rise in the total bilirubin and decrease of alanine aminotransferase level, which escalated risk for development of fulminant hepatitis.

Within 1-6 months, HBsAg was undetectable in 12 of 13 examined patients. Protective anti-HBsAg developed in 10 of them during 2-14 months. Two patients did not develop protective antibodies, but the result of the analysis of PCR HBV DNA was repeatedly negative. Corticosteroids were shortly used in two patients. One patient died four days after starting the therapy. Lamivudine treatment was well tolerated by all patients.

Early treatment with lamivudine can reduce the risk of progression to fulminant hepatitis in patients with SAHB.