| Summary: | Introduction. Experience with lamivudine treatment for acute severe hepatitis
B is limited. Fulminant hepatitis develops in 1% of immunocompetent patients
with acute hepatitis B. Objective. The aim of this study was to evaluate the
efficacy of lamivudine in the treatment of severe acute hepatitis B (SAHB) in
immunocompetent adult patients. Methods. Between January 2006 and May 2013 at
the Clinic for Infectious Diseases Banja Luka, 13 patients with SAHB were
treated with lamivudine at a dose of 100 mg per day. All 13 patients
fulfilled at least two of three default criteria: 1. hepatic encephalopathy;
2. total bilirubin greater than 210 μmol/L; and 3. severe coagulopathy
(international normalized ratio - INR ≥1.5 or prothrombin time - PT <40%).
The criteria were defined according to the experiences reported in the study
of Schmilovitz-Weiss et al. ”Lamivudine treatment for severe acute hepatitis
B“. Nine patients had a rapid rise in the total bilirubin and decrease of
alanine aminotransferase level, which escalated risk for development of
fulminant hepatitis. Results. Within 1-6 months, HBsAg was undetectable in 12
of 13 examined patients. Protective anti-HBsAg developed in 10 of them during
2-14 months. Two patients did not develop protective antibodies, but the
result of the analysis of PCR HBV DNA was repeatedly negative.
Corticosteroids were shortly used in two patients. One patient died four days
after starting the therapy. Lamivudine treatment was well tolerated by all
patients. Conclusion. Early treatment with lamivudine can reduce the risk of
progression to fulminant hepatitis in patients with SAHB.
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