Survival Rate in Patients with HBV-ACLF after Three Months of Antiviral Therapy

Background: A virus which primarily causes inflammation of he liver.The hepatitis B virus can be transmitted in several ways including blood transfusion, needle sticks, body piercing and tattooing using unsterile instruments, dialysis, sexual and evenless intimate close contact, and childbirth.Acute on chronic liver failure (ACLF) is an acute hepatic insult manifested as Jaundice and Coagulopathy, complicated within 4 weeks by clinical ascites and/or Encephalopathy in a patient with previously diagnosed or undiagnosed Chronic Liver Disease/Cirrhosis.It is associated with high 28-day mortality rate ranging from 30% to 70%.Reactivation of Hepatitis B virus infection and super infection with hepatitis A or E are the major causes of ACLF in the Asian region.Liver transplantation is the only definitive therapy though it is not available everywhere and not feasible always.Again MARS therapy (Molecular Adsorbent Recirculating System) didn't reduce mortality significantly.So, antiviral therapy should be started as soon as possible in patients with ACLF due to Hepatitis B irrespective of DNA and ALT status to improve hepatic dysfunction and rescue the patients from mortality.Aims: This randomized clinical trial was carried out with an aimto see survival among patients with acute on chronic hepatitis B liver failure 03 months after the antiviral (Tenofovir or Entecavir) therapy.Methodology: In this study a total of 32 acute on chronic Hepatitis B liver failure patients (age > 18 years with both sexes but male predominant) were included in Hepatology department of Bangabandhu Sheikh Mujib Medical University, Dhaka during January 2013 to December 2015.The patients were randomized into two groups: Tenofovir group (N=16) and Entecavir group (N=16) and followed at least for 03 months.Result: The total study population was 32 Tenofovir and Entecavir ware 15, 13(86.66)tenofovir and entecavir of 7 days.6(60.00)tenofovir and entecavir of 8-15 days.1(14.28)tenofovir and entecavir of 16-28 days.Table-1 demonstrated the Intervention by antiviral at different time of survival rate after three month of early intervention by antiviral (Tenofovir or Entecavir) therapy in HBV-ACLF patients improves survival rate.(n=32).The total study population was 32 Tenofovir and Entecavir ware 15, 2(13.33)had tenofovir and entecavir of 7 days.4(40.00)tenofovir and entecavir of 8-15 days.6(85.71)tenofovir and entecavir of 16-28 days.Table II demonstrated the Intervention by antiviral at different time of survival rate after three month of early intervention by antiviral (Tenofovir or Entecavir) therapy in HBV-ACLF patient's death rate.(n=32.The total study population was 32, Outcome Tenofovir was 9(56.3) had survive and 7(43.7) had death.Outcome entecavirwas 3(18.8) had survive and 13(81.02)had death.Figure I show the Outcome of the ACLF patients three months after the antiviral therapy of Intervention by antiviral at different time of survival rate.And lastly, Out of 07 patients,who got antiviralinterventionwithin 16-28 days of ACLF development or appearance of jaundice and ascites, survivalrate and death rate after three month was 01(14.28%)and 06 (85.71%), respectively(p<0.05).Conclusion: Currently no curative therapy is available.The therapies available to date in habit virus replication, but need to be given long-term.As long as infectedpeople cannot from an adequate immune response, the virus will survive.