Correspondence

Lamivudine in the Treatment of Acute Hepatitis B

N Engl J Med 2000; 343:1123-1124October 12, 2000

Article

To the Editor:

Lamivudine, a nucleoside analogue, has shown promising results in the treatment of hepatitis B virus (HBV) infection through its inhibitory action on reverse-transcriptase activity.1,2 Lamivudine has been used to treat acute hepatitis B after liver transplantation and heart transplantation, and there are now preliminary results from a multicenter trial of its use after liver transplantation.3,4 We report the use of lamivudine in a 74-year-old woman with acute hepatitis B.

The patient was admitted because of acute hepatitis B of two months' duration. Physical examination revealed a well-nourished, conscious woman with mild jaundice but otherwise normal findings. There was no hepatomegaly, and there were no signs of chronic liver disease. The blood count, prothrombin time, and levels of urea, creatinine, sodium, potassium, and calcium were normal. Other values obtained were as follows: albumin, 3.4 g per deciliter; bilirubin, 3.5 mg per deciliter (predominantly direct); alanine aminotransferase, 763 U per liter; and aspartate aminotransferase, 908 U per liter. Liver scanning and abdominal ultrasonography revealed no abnormalities. Serologic tests were positive for hepatitis B surface antigen (HBsAg), IgM antibodies to hepatitis B core antigen, and hepatitis B e antigen (HBeAg). Use of the polymerase chain reaction revealed the presence of HBV DNA. Tests for IgM antibodies to hepatitis A virus, antibodies to hepatitis C virus, and antibodies to hepatitis delta virus were negative. Gradually, the aminotransferase levels rose, and the following values were obtained: aspartate aminotransferase, 1147 U per liter; alanine aminotransferase, 1185 U per liter; bilirubin, 4.1 mg per deciliter; and albumin, 3 g per deciliter. Signs of encephalopathy developed.

At this stage, and because of the threat of subacute hepatic failure, we started treatment with lamivudine at a dose of 100 mg per day after informed consent had been obtained. Gradually, the aminotransferase levels decreased and after four weeks became normal; tests for HBeAg and HBV DNA became negative; and the bilirubin and albumin levels returned to normal. Tests for HBsAg remained positive. After four months of treatment, lamivudine was discontinued, and the patient remained well, with normal results on liver-function tests. Two months after lamivudine was discontinued, HBsAg was no longer detected.

Lamivudine has been approved for the treatment of chronic hepatitis B, and recent studies in Asia and the United States2,5 confirmed the efficacy and safety of the drug. The goals of treatment are the prevention of liver fibrosis and cancer by long-term suppression of HBV replication and integration of viral DNA into the hepatocytes. Clearly, there is urgent need for a drug that may prevent these steps in the progression of the infection. Our report suggests the need for a randomized, prospective study of lamivudine in patients with acute hepatitis B. Meanwhile, the possible use of this promising drug should be considered in selected patients with acute hepatitis B.

Ron Reshef, M.D.
Wisam Sbeit, M.D.
Western Galilee Hospital, 22100 Naharyia, Israel

Ran Tur-Kaspa, M.D.
Rabin Medical Center, 49100 Petach-Tikva, Israel

5 References

1. 1

   Dienstag JL, Perrillo RP, Schiff ER, Bartholomew M, Vicary C, Rubin M. A preliminary trial of lamivudine for chronic hepatitis B infection. N Engl J Med 1995;333:1657-1661
   Full Text | Web of Science | Medline

2. 2

   Lai C-L, Chien R-N, Leung NWY, et al. A one-year treatment of lamivudine for chronic hepatitis B. N Engl J Med 1998;339:61-68
   Full Text | Web of Science | Medline

3. 3

   Andreone P, Caraceni P, Grazi GL, et al. Lamivudine treatment for acute hepatitis B after liver transplantation. J Hepatol 1998;29:985-989
   CrossRef | Web of Science | Medline

4. 4

   Perrillo R, Rakela J, Martin P, et al. Lamivudine for hepatitis B after liver transplantation (OLT). Hepatology 1996;24:Suppl:182A-182A abstract.
   CrossRef | Web of Science

5. 5

   Dienstag JL, Schiff ER, Wright TL, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 1999;341:1256-1263
   Full Text | Web of Science | Medline

Citing Articles (14)

Citing Articles

1. 1

   , Doan Y. Dao, Emmanuel Seremba, Veeral Ajmera, Corron Sanders, Linda S. Hynan, William M. Lee. (2011) Use of Nucleoside (Tide) Analogues in Patients with Hepatitis B-Related Acute Liver Failure. Digestive Diseases and Sciences
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   Francisco Javier García-Alonso, Rosa María Martín-Mateos, Víctor Moreira Vicente. (2011) Tratamiento farmacológico de la hepatitis B aguda. Medicina Clínica
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3. 3

   Helen S. Te. (2010) Treatment of Acute Hepatitis B with Nucleoside and/or Nucleotide Analogues. Current Hepatitis Reports 9:2, 119-123
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   Jian-Wu Yu, Li-Jie Sun, Yong-Hua Zhao, Peng Kang, Shu-Chen Li. (2010) The Study of Efficacy of Lamivudine in Patients with Severe Acute Hepatitis B. Digestive Diseases and Sciences 55:3, 775-783
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   Dragan Delic, Zorica Nesic, Milica Prostran, Ivan Boricic, Neda Svirtlih. (2009) Treatment of subacute hepatitis B with lamivudine: A pilot study in Serbia. Vojnosanitetski pregled 66:3, 199-202
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   M. Kumar, S. Satapathy, R. Monga, K. Das, S. Hissar, C. Pande, B. C. Sharma, S. K. Sarin. (2007) A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology 45:1, 97-101
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   Kaku Omori, Nobuyuki Torii, Kiyoshi Hasegawa, Etsuko Hashimoto, Keiko Shiratori. (2007) Analysis of patients who received lamivudine for acute hepatitis B of genotype A. Kanzo 48:4, 145-152
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   M. Umeda, H. Marusawa, M. Ueda, Y. Takada, H. Egawa, S. Uemoto, T. Chiba. (2006) Beneficial Effects of Short-Term Lamivudine Treatment for de novo Hepatitis B Virus Reactivation After Liver Transplantation. American Journal of Transplantation 6:11, 2680-2685
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9. 9

   B Laubscher, M Gehri, M Roulet, S Wirth, P Gerner. (2005) Survival of Infantile Fulminant Hepatitis B and Treatment with Lamivudine. Journal of Pediatric Gastroenterology and Nutrition 40:4, 518-520
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10. 10

    Pérez-Roldán, Francisco, González-Carro, Pedro, Villafáñez-García, María Concepción, . (2005) Adefovir Dipivoxil for Chemotherapy-Induced Activation of Hepatitis B Virus Infection. New England Journal of Medicine 352:3, 310-311
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    H. Schmilovitz-Weiss, Z. Ben-Ari, E. Sikuler, E. Zuckerman, W. Sbeit, Z. Ackerman, R. Safadi, Y. Lurie, G. Rosner, R. Tur-Kaspa, R. Reshef. (2004) Lamivudine treatment for acute severe hepatitis B: a pilot study. Liver International 24:6, 547-551
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12. 12

    C. Lentschener, Y. Ozier. (2003) What anaesthetists need to know about viral hepatitis. Acta Anaesthesiologica Scandinavica 47:7, 794-803
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13. 13

    Rauf Haznedar, Mnci Ya?c?. (2002) Lamivudine therapy for acute hepatitis B infection following peripheral blood stem cell transplantation. American Journal of Hematology 69:2, 151-151
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14. 14

    Gupta, Samardeep, Piraka, Cyrus, Jaffe, Michele, . (2001) Lamivudine in the Treatment of Polyarteritis Nodosa Associated with Acute Hepatitis B. New England Journal of Medicine 344:21, 1645-1646
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