| Adequacy of Immediate Lamivudine Trial for Chronic Hepatitis B Patients with Acute Exacerbation |
| Chun Kyon Lee, M.D., Jeong Hun Suh, M.D., Yong Suk Cho, M.D.,
Sun Young Won, M.D. and In Suh Park, M.D. |
| Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital |
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| ABSTRACT |
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Background/Aims
It has been unclear whether immediate antiviral therapy or observation under the
expectation of spontaneous inactivation of hepatitis B virus (HBV), is more appropriate for the treatment of
chronic hepatitis B (CHB) with acute exacerbation. We intended to analyze the short-term natural course of
CHB with acute exacerbation and evaluate the efficacy of lamivudine. Methods: We analyzed 35 CHB
patients with acute exacerbation (positive HBV DNA or HBeAg and ALT>400 IU/L) between March 2000
and May 2003. We regularly checked serum HBV DNA, HBeAg and liver function tests including ALT every
1 to 3 months. If ALT was above 100 IU/L during the follow-up period, patients were treated with 100 mg
lamivudine orally once a day. We compared the efficacy of lamivudine use between this group and the group
provided with immediate lamivudine trial at their first visit. Results: 27 CHB patients with acute
exacerbation were observed without immediate lamivudine trial. In 5 of these patients normal ALT, negative
HBeAg and HBV DNA were maintained during 19 months (group 1a). Slightly elevated or normal ALT was
maintained without HBeAg seroconversion in 3 patients (group 1b). However, serum ALT flared up above
100 IU/L in 19 patients within 5 months. So, lamivudine was tried on these patients (group 2). The serum
HBV DNA was extremely low, being 6.5 pg/mL in group 1a compared to 518.1 pg/mL in group 2.
Spontaneous inactivation of HBV was observed in 71.4% (5/7) of patients with HBV DNA less than 20 pg/
mL at the first visit. ALT was lower and HBV DNA was higher in group 2 than the 8 patients who received
immediate lamivudine trial at the first visit (group 3). The response rate of lamivudine was similar between
group 2, 56.3% (9/16) and group 3, 62.5% (5/8). Conclusions: Spontaneous inactivation of HBV was
expected in CHB with acute exacerbation and extremely low level of HBV DNA (less than 20 pg/mL) in a
short term follow-up period. Immediate lamivudine therapy might be more appropriate in most CHB patients
with acute exacerbation.(Korean J Hepatol 2004;10:22-30) |
| KeyWords:
Chronic hepatitis B, Acute exacerbation, Lamivudine |
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