Lamivudine monotherapy for spontaneous severe acute exacerbation of chronic hepatitis B

Background: Severe acute exacerbations of chronic hepatitis B virus (HBV) infection can spontaneously occur and rapidly progress to fatal hepatic failure. The purpose of the present paper was to identify factors that could influence the rapid progression of liver disease to hepatic failure, and assess the effects of lamivudine on serious disease. Methods: Twenty‐five patients with spontaneous severe acute exacerbation (accompanied by jaundice and coagulopathy) were consecutively treated with lamivudine. Their clinical outcomes were compared with those of 25 lamivudine‐untreated patients, as historical controls. Results: Six lamivudine‐treated patients (24%)and seven controls (28%) rapidly developed hepatic failure. Lamivudine monotherapy did not significantly prevent progression to hepatic failure. Multivariate analysis identified baseline serum bilirubin ≥6 mg/dL (odds ratio [OR]: 5.61; 95% confidence interval [CI]: 1.66–21.61; P  = 0.018), pre‐existing cirrhosis (OR: 4.52; 95%CI: 1.26–30.42; P  = 0.034), and baseline prothrombin time <40% (OR: 3.75; 95%CI: 1.03–43.86; P  = 0.045) as independent determinants of the event. Of the aforementioned patients with hepatic failure, three lamivudine‐treated patients (50%) and two controls (29%) survived ( P  > 0.15). However, lamivudine induced a sustained normalization of liver function and inhibited the development of cirrhosis in survivors. Conclusions: Lamivudine monotherapy conferred no significant protection against rapid progression of the disease to hepatic failure, but it resulted in long‐term benefits. Lamivudine combined with other drugs could be more beneficial for patients with the aforementioned risk factors. © 2004 Blackwell Publishing Asia Pty Ltd