Background and aim: Acute hepatitis B can progress to liver failure in about 1% of patients who may require liver transplantation. Lamivudine has been shown to be able to prevent acute liver failure and liver transplantation when administered early enough on the course of disease. Very recently, data on tenofovir disoproxil fumarate (TDF) were presented suggesting that this drug is one of the most promising alternatives for patients with chronic hepatitis B. We assessed the clinical value of TDF in patients with severe acute hepatitis B.
Patients: Between June and December 2006, five (F: M=3/2; mean age: 34 ys) of the 11 patients who presented with severe acute hepatitis B in our clinic were treated with TDF (Viread) in a dose of 245mg per day for 8–16 weeks. The infection was transmitted sexually in all treated patients. A 25-year young lady with a HBeAg negative fulminant hepatitis who was evaluated for liver transplant because of severe coagulopathy and encephalopathy received TDF. Two patients were given TDF because of a severe cholestatic form (bilirubin >40mg/dL) of acute hepatitis B. Further two patients received the drug because they developed severe symptomatic acute hepatitis or a protracted course of the disease. All the non-fulminant cases were infected with the 'wild-type' virus and were considered for treatment only after an approximately four-week observation period.
Results: The patient with fulminant hepatitis B improved rapidly in one week after initiation of the therapy. The symptomatic non-fulminant cases experienced a significant clinical improvement after about two-weeks therapy with TDF. Viral load fell rapidly (initial mean viral load: 60.19*106 copies/mL; range: 2.08* 106–161.65*106 copies/mL) and was under the detection limit (<300 copies/mL) 10–16 weeks after initiation of the therapy. Loss of HBsAg with seroconversion to anti-HBs was seen in all patients. Clinically significant side effects were not reported.
Conclusion: Tenofovir disoproxil fumarate is effective and safe in patients with severe acute hepatitis B.
Acute hepatitis B - Tenofovir
