Background/Aims
Lamivudine is an oral nucleoside analogue with potent antiviral activity against HBV inducing normalization of ALT and improvement of necro-inflammation and fibrosis in chronic hepatitis B. But its role in decompensated cirrhosis has not been established. The Child-Pugh score is a reliable and convenient prognostic indicator reflecting liver synthetic function. We evaluated the incidence of any improvement in Child-Pugh score after lamivudine treatment in patients with decompensated cirrhosis. Methods: Twenty-six patients with HBV associated active decompensated cirrhosis showing detectable serum HBV received lamivudine (100 or 150 mg/day) for 6-45 months (median 16). The Child-Pugh score at 6th month of lamivudine treatment was compared with base line score. Results: The Child-Pugh score improved ( 2-point reduction) in 17 (65.4%) patients, was constant in 8 (30.8%), and aggravated ( 2-point increase) in one (3.8%) of 26 patients. HBV DNA was initially cleared in 24 cases (92.3%) but breakthrough developed in 7 (29.2%). HBeAg was lost in 5 (25%) of 20 cases. Initial improvement was maintained in 14 (82.4%) of 17 cases but aggravated with breakthrough in 3 (17.6%). Two of 5 patients waiting for liver transplantation showed marked improvement and were removed from the list. Conclusion: Lamivudine can be an effective treatment for patients with decompensated cirrhosis due to HBV infection, improving the Child-Pugh score in many cases. However, deterioration of liver function associated with DNA breakthrough was an important problem in patients showing initial improvement.
