Acute hepatitis B: is antiviral therapy necessary? Two illustrative case reports

May 28, 2008

Dtsch Med Wochenschr. 2008 May;133(22):1178-82.

[Acute hepatitis B: is antiviral therapy necessary? Two illustrative case

reports]

[Article in German]

Girke J, Wedemeyer H, Wiegand J, Manns MP, Tillmann HL.

Zentrum Innere Medizin, Abteilung Gastroenterologie, Hepatologie und

Endokrinologie, Med. Hochschule Hannover.

INTRODUCTION: The efficiacy of Entecavir and Adefovir for treatment of acute

hepatitis B is not known. HISTORY: Two women with severe acute hepatitis B (HB)

complained about a skin rash as well as jaundice, nonspecific epigastric and

joint discomfort. LABORATORY FINDINGS: Both patients had severe liver cell

damage caused by the HB virus. Transaminases were elevated up to 150 times the

normal range (normal: ALT up to 34 U/l, AST up to 31 U/l) and bilirubin was

raised up to 35 times above normal (17 micromol/l). Liver synthesis, as measured

by the Quick time test, was already impaired. High titers of HBs-antigen and

HBV-DNA were detected. TREATMENT AND COURSE: Both patients were immediately

admitted for antiviral therapy with lamivudine, in view of the prolonged

prothrombin time. But there was no evidence of adequate recovery of liver

function. Improvement followed after switching the antiviral therapy to

entecavir or to an add-on with adefovir, respectively. CONCLUSION: Recently

available nucleos(t)ide analogs, such as entecavir and adefovir, seem to be

efficacious in acute hepatitis B therapy when lamivudine has failed. When

prothrombin time is substantially prolonged, antiviral therapy is recommended.

However, there is no consensus on antiviral therapy of acute hepatitis B in

general, because data from large studies are still lacking. The findings

described here suggest that such patients with acute hepatitis B should be

treated within the German GAHB study (German acute hepatitis B study:

Publication Types:

English Abstract

PMID: 18491273 [PubMed - in process]

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