Early Treatment With Nucleotide/Nucleoside Analogues Safe, Effective for HBV-Induced Liver Failure: Presented at AASLD

By Kari Oakes

WASHINGTON, DC -- November 8, 2013 -- Immediate treatment of hepatitis B virus (HBV)-induced acute liver failure with nucleotide/nucleoside analogues is well tolerated and avoids liver transplantation, researchers said here on November 3 at the 64th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

In addition, treatment with nucleotide/nucleoside analogues does not appear to negatively influence HBsAg clearance, reported Felix Maischack, MD, Universitaetsklinikum Essen, Universitaet Duisburg-Essen, Essen, Germany.

Of the 24 patients in the study with HBV and acute liver failure, 16 received entecavir, 2 received lamivudine, and 4 patients received tenofovir between day 1 and day 28 after hospital admission. Two patients did not receive treatment.

All patients who received treatment survived and did not need liver transplantation. One of the 2 patients who did not receive HBV-treatment died before getting transplantation and the other was lost to follow-up.

In all treated patients pathological parameters rapidly decreased and returned to normal values within 3 months.

Sixteen patients lost their HBsAg between 1 month and 1 year after diagnosis. A seroconversion to anti-HBsAg was achieved in 9 out of the 16 patients between 59 and 168 days, with seroconversion to anti-HBsAg in 10 of the 16 (62.5%) at a median 134 days.

Of the 6 patients who did receive treatment and did not show HBsAg clearance 5 were lost to follow-up between discharge from the hospital and 3 months thereafter.

There were no side effects observed related to treatment.

The authors acknowledged that the clear benefit of treatment with nucleotide/nucleoside analogues analogues for HBV-caused acute liver failure has still not been established. Specifically, long-term outcomes and the possibility of long-term complications have not been well examined.

However, in considering the findings of this small retrospective study, patients who did receive nucleotide/nucleoside analogues fared well without significant differences in outcome according to the drug used, suggesting a class effect. Choosing drugs with a high resistance barrier may still be advisable.

[Presentation title: Hepatitis B-associated Acute Liver Failure: Immediate Treatment With Entecavir/Tenofovir Safely Avoids Transplantation and Does Not Interfere With HBsAg Clearance. Abstract 1000]

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