Lamivudine induced stable reversal in HBV liver cirrhosis Child C: a case report.

A 40-year-old viremic woman with HBV related liver cirrhosis (Child-Plugh - C) received 100 mg lamivudine daily for 24 months. Initially the patient was with hepato-splenomegaly, marked ascites and mild jaundice. There were no signs of portal encephalopaty and gastrointestinal haemorrhage. The baseline ALT was about 6 times above the upper limit of normal. Hypoalbuminemia of 29 g/l as well as hyperbilirubinemia of 40 mmol/L and decreased protrombin index of 47% was found. Serological tests showed positive serum HBsAg and anti-HBe antibodies. The patient was HBeAg negative, but with detectable serum HBV DNA (500 pg/mL) by dot-blot hybridization HDV, HCV and HIV co-infections were excluded. A marked improvement in liver function had been found at the end of the third month of therapy, with normalization of bilirubin and ALT activity. Serum albumin and protrombine index increased from 29 g/l to 36 g/l and from 47% to 92%, respectively. The patient was without ascites and Child-Plough score decreased from 10 to 5 points. Serum HBV DNA rapidly decreased at the end of first treatment month and was undetectable three months after the initiation of lamivudine therapy. We found two viremic episodes during the lamivudine treatment. However, Child-Pugh score did not increased and the patient remained with compensated liver disease and with lower ALT than baseline value. The main question is haw long such patients have to receive the lamivudine treatment.

Chronic HBV infection. Immunomodulation with levamisole in viremic HBeAg positive or anti-HBe positive patients--a pilot study.

BACKGROUND/AIMS: We evaluated the effect of immunomodulatory treatment with levamisole in HBeAg positive or anti-HBe positive patients with chronic HBV infection and ongoing viral replication. The majority of patients had an expected poor response to IFN-alpha. METHODOLOGY: Twenty-five viremic patients (15 males and 10 females) with chronic HBV infection were treated with Levamisole for 12 months or until negative serum HBV DNA occurred for at least 3 months. Viral replication and aminotransferase activity were controlled at the end of 3, 6, 9 and 12 months during the treatment. RESULTS: A decrease of serum HBV DNA was noted when serum HBV DNA levels before and after treatment with levamisole were compared, by t-test for dependent samples (p < 0.05). There was a significant reduction of ALT activity, too. HBV DNA fell below the detection limit of our assay at the end of 3, 6, 9 and 12 months in 7, 7, 8 and 10 of the patients, respectively. In 3 of 16 initially HBeAg positive patients, seroconversion to anti-HBe antibody occurred. At the end of 12 months 10 patients were with negative serum HBV DNA and normal ALT activity. Two of them lost HBsAg during the treatment. Ten patients were without any effect from the therapy. The potential responder initially is anti-HBe positive, with low serum HBV DNA < 500 pg/ml and low ALT activity (< 3 times the upper limit of normal). CONCLUSIONS: Immunomodulation with levamisole may benefit some patients with chronic ongoing viral replication including patients with expected poor response to IFN-alpha. This treatment could be used as an alternative therapeutic schedule in patients contraindicated for IFN-alpha, and also because it lowers treatment costs.