Lamivudine Treatment Improves the Prognosis of Fulminant Hepatitis B

Abstract

Objective The efficacy of lamivudine for fulminant hepatitis B has been reported in Europe and West Asia. However, in

British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013

“…In a systematic review and meta-analysis of five studies, an increased-dose HBV vaccination schedule improved anti-HBs response rates compared to standard-dose HBV vaccination (OR 1.96; 95% CI: 1.47, 2.61) with separate randomised trial data demonstrating improved serological response with four-dose regimens [67][68][69][70][71]. An accelerated course (three doses given at 0, 1 and 3 weeks) of low-dose vaccine was non-inferior to a standard course (three doses given at months 0, 1 and 6) only in those with CD4 counts above 500 cells/μL with no data existing for a similar schedule using double-dose vaccine [72].…”

“…Another RCT in monoinfected patients treated with either 3TC or no antivirals for acute severe HBV showed a threefold reduction in liver failure and death in the 3TC arm, although the survivors in the placebo arm were less likely to become chronically infected [67]. Two retrospective case-control studies of monoinfected patients treated with 3TC for fulminant hepatitis B showed a three-fold reduction in mortality in the treated patients, and none of the survivors progressed to chronic infection [68,69].…”

“…There is some evidence to support the efficacy of tenofovir in acute severe/fulminant HBV from case reports in HIV-infected individuals, although in these it was administered in combination with 3TC or FTC [70][71][72][73]. In published studies, the anti-viral agent has been given until the patient seroconverts from HBsAg positive to anti-HBs, which in most cases is within 3-6 months [67][68][69][70][71][72][73][74][75][76], or if the infection becomes chronic, continued indefinitely as per recommendations. All patients with acute severe/fulminant HBV need to be cared for in a hospital with expertise in the specialised care of this issue and with access to a specialised ITU.…”

“…The advent of DAAs has dramatically altered the outcome of treatment of hepatitis C in both monoinfected and coinfected patients. Two HCV protease inhibitors are presently licensed and have NICE approval for the treatment of HCV in coinfected patients: telaprevir and boceprevir [69,70]. Both are active only against HCV genotype 1 and when combined with pegylated interferon and ribavirin have led to higher rates of success in the monoinfected population.…”

Letter: acute hepatitis B – to treat or not to treat?

“…A study 3 detected strong production of protein MxA (a specific marker for IFN signalling) in the inflammatory cells of skin samples of anti-TNF-a-induced psoriasis as compared with controls. Another study 7 found increased IFN-a expression in the psoriatic lesions of patients receiving anti-TNF-a therapy, as compared with spontaneous psoriasis. Furthermore, since the time between anti-TNF-a administration and the development of psoriatic lesions may be extremely variable, 2 an environmental trigger could be involved in this pathophysiological mechanism.…”