Lamivudine treatment in patients with decompensated cirrhosis due to hepatitis B

Objective To evaluate the efficacy and safety of lamivudine in treating for decompensated cirrhosis due to chronic hepatitis B.Methods Sixty patients with decompensated cirrhosis of hepatitis B virus infection were randomly divided treatment group(30 cases) and control group(30 cases),which were matched for age ,gender,liver function and Child-Pugh score.Treatment group were treated with lamivudine 100 mg orally once daily.Supportive treatment and symptomatic treatment were given in two groups.Results The median follow-up was 26 months in the patients of treatment group.Symptoms of all patients were relieved gradually after 3 to 6 months.Ascites disappeared in all patients.The rates of negative conversion for the serum HBV-DNA were 76.67%(23/30) in the patients of treatment group after 1 year of lamivudine therapy.There was a significant improvement in clinical symptoms and liver function,with an increase in serum albumin and PTA,and a decrease in total serum bilirubin and Child-Pugh score.Two year survival rate was 93.33%.The complication rate and the re-admission rate were also markedly reduced.The rates of YMDD mutation treated groups were 6.7%(2/30) and 33.3%(10/30)in 1 year and 2 years respectively.Obvious clinical improvement was observed following the prompt addition of adefovir dipivoxil to lamivudine in decompensated patients with YMDD variant HBV.Conclusion Lamivudine therapy can result in a significant improvement of liver function and the prolonging of survival time in patients with decompensated HBV cirrhosis.The prompt addition of newer antiviral agents such as adefovir dipivoxil with activity against the YMDD mutants to lamivudine can effectively inhibit mutated HBV replication and prevent the acute exacerbation of liver function once the YMDD mutant emerges.