Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure.

[Guest guest]

Hepatology. 2010 Dec 14. doi: 10.1002/hep.24109. [Epub ahead of print]

Tenofovir improves the outcome in patients with spontaneous reactivation of

hepatitis B presenting as acute-on-chronic liver failure.

Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A.

From the Department of Gastroenterology, GB Pant Hospital, New Delhi, India;

Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New

Delhi, India.

Abstract

Spontaneous reactivation of chronic hepatitis B (CHB) is an important cause of

acute-on-chronic liver failure (ACLF). Antiviral drugs may help reduce the high

morbidity and mortality in such patients, especially in places where liver

transplant is not available. The aim was to evaluate the efficacy of tenofovir

and to determine the predictors of mortality in patients with spontaneous

reactivation of CHB with ACLF. Consecutive patients of ACLF due to spontaneous

reactivation of CHB were randomized to receive either tenofovir or placebo. The

primary endpoint was survival at 3 months. Of the 90 patients with ACLF of

different etiologies, 27 (26%) were due to reactivation of CHB and were

enrolled. The median baseline hepatitis B virus (HBV) DNA level was 9 × 10(5)

IU/mL. Fourteen patients received tenofovir and 13 placebo. At 3 months the

probability of survival was higher in the tenofovir than the placebo group (8/14

[57%] versus 2/13 [15%], respectively; P = 0.03). The cause of death in the 15

patients was progressive liver failure leading to multiorgan failure. Liver

transplantation could not be offered due to its nonavailability. In the

surviving patients, there was a significant improvement in the Child-Turcotte

Pugh (CTP) and model for endstage liver disease (MELD) scores and significant

decline in the HBV DNA levels in the tenofovir group, whereas these parameters

did not change significantly in the placebo group. More than 2 log reduction in

HBV DNA levels at 2 weeks was found to be an independent predictor of survival.

Conclusion: Tenofovir significantly reduces HBV-DNA levels, improves CTP and

MELD scores, and reduces mortality in patients with severe spontaneous

reactivation of CHB presenting as ACLF. Reduction in HBV-DNA levels at 2 weeks

should be a desirable goal and is a good predictor of survival.

(HEPATOLOGY 2011;.).

[Guest guest]

Hepatology. 2010 Dec 14. doi: 10.1002/hep.24109. [Epub ahead of print]

Tenofovir improves the outcome in patients with spontaneous reactivation of

hepatitis B presenting as acute-on-chronic liver failure.

Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A.

From the Department of Gastroenterology, GB Pant Hospital, New Delhi, India;

Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New

Delhi, India.

Abstract

Spontaneous reactivation of chronic hepatitis B (CHB) is an important cause of

acute-on-chronic liver failure (ACLF). Antiviral drugs may help reduce the high

morbidity and mortality in such patients, especially in places where liver

transplant is not available. The aim was to evaluate the efficacy of tenofovir

and to determine the predictors of mortality in patients with spontaneous

reactivation of CHB with ACLF. Consecutive patients of ACLF due to spontaneous

reactivation of CHB were randomized to receive either tenofovir or placebo. The

primary endpoint was survival at 3 months. Of the 90 patients with ACLF of

different etiologies, 27 (26%) were due to reactivation of CHB and were

enrolled. The median baseline hepatitis B virus (HBV) DNA level was 9 × 10(5)

IU/mL. Fourteen patients received tenofovir and 13 placebo. At 3 months the

probability of survival was higher in the tenofovir than the placebo group (8/14

[57%] versus 2/13 [15%], respectively; P = 0.03). The cause of death in the 15

patients was progressive liver failure leading to multiorgan failure. Liver

transplantation could not be offered due to its nonavailability. In the

surviving patients, there was a significant improvement in the Child-Turcotte

Pugh (CTP) and model for endstage liver disease (MELD) scores and significant

decline in the HBV DNA levels in the tenofovir group, whereas these parameters

did not change significantly in the placebo group. More than 2 log reduction in

HBV DNA levels at 2 weeks was found to be an independent predictor of survival.

Conclusion: Tenofovir significantly reduces HBV-DNA levels, improves CTP and

MELD scores, and reduces mortality in patients with severe spontaneous

reactivation of CHB presenting as ACLF. Reduction in HBV-DNA levels at 2 weeks

should be a desirable goal and is a good predictor of survival.

(HEPATOLOGY 2011;.).