The Effect of Lamivudine in HBV-positive Patients with Progressively Aggravating Chronic Liver Disease and Active HBV DNA Multiplication

Lee, Heon Ju

Abstract

BACKGROUND/AIM: Lamivudine, a reverse-transcriptase inhibitor interferes with viral replication and can reduce the level of infection, thus diminishing an attack by the immune system. The study was conducted to determine whether lamivudine therapy would result in improved clinical course and serological tests in HBV-positive patients with aggravating liver tests.
METHODS
Among the 116 patients with chronic replicative progressive hepatitis B and aggravating clinical course, 63 patients were in the lamivudine (100mg daily) group, 23 in the interferon alpha group and 30 were in the non-treated group were enrolled in this study. The effect of lamivudine therapy given for one year was evaluated by serologic tests on a bimonthly basis. The duration of lamivudine treatment was 6-12 months.
RESULTS
The results show that ALT normalization occurred in 56.1% of lamivudine group in the sixth month, while 39.1% of interferon alpha group and 10.0% occurred in the non-treated control group. Negative conversions in both the HBV DNA and HBeAg were achieved in 100% and 26.0% of lamivudine group, while 56.5% and 17.4% were achieved in the interferon alpha group and only 13.3% and 3.3% were achieved in the non-treated group. After 8 to 12 months of therapy six cases revealed HBV DNA breakthrough but AST, ALT flare up occurred concomitantly among 3 of them. The proportions of patients with ALT normalization and seroconversion at 1 year of lamivudine therapy were 82.5% and 16.1% respectively.
CONCLUSION
Lamivudine treatment is associated with suppression in HBV replication and ALT levels in patients with chronic progressive hepatitis impending or ongoing liver cirrhosis by HBV without any side reaction or complication. However, it is necessary to consider the elevation of AST, ALT levels and/or reappearance of high serum level of HBV DNA under the lamivudine therapy and the influence of long-term viral suppression on the long-term outcome.