entecavir and Acute-Disease

Infection with hepatitis B virus (HBV) can be symptomatic or asymptomatic. Apart from chronic HBV infection, the complications related to acute HBV infection are severe acute viral hepatitis and fulminant hepatitis characterised by liver failure. The optimal pharmacological treatment of acute HBV infection remains controversial.. To assess the benefits and harms of pharmacological interventions in the treatment of acute HBV infection through a network meta-analysis and to generate rankings of the available treatments according to their safety and efficacy. As it was not possible to assess whether the potential effect modifiers were similar across different comparisons, we did not perform the network meta-analysis, and instead, assessed the benefits and harms of different interventions using standard Cochrane methodological procedures.. We searched CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, WHO International Clinical Trials Registry Platform, and randomised clinical trials (RCTs) registers to August 2016 to identify RCTs on pharmacological interventions for acute HBV infection.. RCTs, irrespective of language, blinding, or publication status in participants with acute HBV infection. We excluded trials if participants had previously undergone liver transplantation and had other coexisting viral diseases such as hepatitis C virus and HIV. We considered any of the various pharmacological interventions compared with each other or with placebo, or no intervention.. We calculated the odds ratio (OR) and rate ratio with 95% confidence intervals (CI) using both fixed-effect and random-effects models based on available-participant analysis with Review Manager 5. We assessed risk of bias, controlled risk of random errors with Trial Sequential Analysis, and assessed the quality of the evidence using GRADE.. Seven trials (597 participants) met our review inclusion criteria. All trials provided information for one or more outcomes; however, five participants were excluded from analysis by study authors. All the trials were at high risk of bias. Overall, all the evidence was low or very low quality evidence because of risk of bias (downgraded one level for risk of bias), small sample size (downgraded one level for imprecision), and wide CIs (downgraded one more level for imprecision in some comparisons). Of the seven trials, six were two-armed trials, while one trial was a three-armed trial. The comparisons included hepatitis B immunoglobulin (HBIG) versus placebo (one trial; 55 participants); interferon versus placebo (two trials; 200 participants); lamivudine versus placebo or no intervention (four trials; 316 participants); lamivudine versus entecavir (one trial; 90 participants); and entecavir versus no intervention (one trial; 131 participants). One trial included only people with acute HBV with hepatic encephalopathy (i.e. people with fulminant liver failure); one trial included only people with severe acute HBV, but it did not state whether any of the people also had fulminant HBV infection; three trials excluded fulminant HBV infection; and two trials did not report the severity of acute HBV infection. The mean or median follow-up period in the trials ranged from three to 12 months in the trials that provided this information.There was no evidence of any differences in short-term mortality (less than one year) in any of the comparisons: HBIG versus placebo (OR 1.13, 95% CI 0.36 to 3.54; participants = 55; 1 trial), lamivudine versus placebo or no intervention (OR 1.29, 95% CI 0.33 to 4.99; participants = 250; 2 trials); lamivudine versus entecavir (OR 1.23, 95% CI 0.13 to 11.65; participants = 90; 1 trial), or entecavir versus no intervention (OR 1.05, 95% CI 0.12 to 9.47; participants = 131; 1 trial). The proportion of people who progressed to chronic HBV infection was higher in the lamivudine group than the placebo or no intervention group (OR 1.99, 95% CI 1.05 to 3.77; participants = 285; 3 trials) and in the lamivudine group versus entecavir group (OR 3.64, 95% CI 1.31 to 10.13; participants = 90; 1 trial). There was no evidence of a difference in the proportion of people who progressed to chronic HBV infection between the entecavir and the no intervention groups (OR 0.58, 95% CI 0.23 to 1.49; participants = 131; 1 trial). None of the trials reporte. Low or very low quality evidence suggests that progression to chronic HBV infection was higher in people receiving lamivudine compared with placebo, no intervention, or entecavir. Low quality evidence suggests that interferon may increase the adverse events after treatment for acute HBV infection. Based on a very low quality evidence, there is currently no evidence of benefit of any intervention in acute HBV infection. There is significant uncertainty in the results and further RCTs are required.

Topics: Acute Disease; Antiviral Agents; Disease Progression; Guanine; Hepatic Encephalopathy; Hepatitis B; Hepatitis C, Chronic; Humans; Immunization, Passive; Interferons; Lamivudine; Network Meta-Analysis; Odds Ratio; Randomized Controlled Trials as Topic; Reverse Transcriptase Inhibitors

The incidence of acute B hepatitis is decreasing due to socioeconomical changes and the implementation of vaccination programs. Nevertheless it is potentially severe, causing approximately 30% of acute liver failures in Spain. Pharmacological treatment of acute B hepatitis has become a matter of issue over the last decade. This text offers a review of the published data and international guidelines. Most published studies have a low methodological quality and lamivudine was used as treatment in all of them. A survival improvement with prompt treatment has been shown in acute liver injury and probably in severe acute hepatitis (total bilirubin>10mg/dl and INR>1.5). International guidelines support treatment in these cases, but there is no consensus on the drug to use or the length of treatment.

Topics: Acute Disease; Adenine; Antiviral Agents; Guanine; Hepatitis B; Humans; Lamivudine; Nucleosides; Organophosphonates; Practice Guidelines as Topic; Pyrimidinones; Spain; Telbivudine; Tenofovir; Thymidine; Treatment Outcome

Topics: Acute Disease; Anticoagulants; Antiviral Agents; Carrier State; Clinical Trials as Topic; Diagnosis, Differential; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Guanine; Hepatitis B; Humans; Interferons; Lamivudine

Topics: Acute Disease; Antiviral Agents; Carrier State; Cyclosporine; Drug Therapy, Combination; Guanine; Hemodiafiltration; Hepatitis B; Humans; Immunosuppressive Agents; Lamivudine; Liver Failure, Acute; Liver Transplantation; Methylprednisolone; Plasma Exchange; Prognosis; Pulse Therapy, Drug

The clinical presentation of acute hepatitis B virus (HBV) infection is usually related to the onset of liver failure and damage. Anaemia may occur, but it is only rarely attributed to haemolysis. The authors report about the case of a 41-year-old woman with the diagnosis of acute HBV infection and coagulopathy (without encephalopathy) who developed non-immune haemolytic anaemia. Total recovery of the analytical liver profile, coagulopathy and anaemia was achieved through treatment targeting HBV.This case shows that, although rare, non-immune haemolytic anaemia may occur in association with acute HBV infection and that HBV suppression seems to lead to progressive anaemia resolution.

Topics: Acetylcysteine; Acute Disease; Adult; Anemia, Hemolytic; Antiviral Agents; Female; Folic Acid; Guanine; Hepatitis B; Humans; Treatment Outcome; Vitamin B Complex; Vitamin K; Vitamins

Reported HBV drug resistance mutations among previously untreated patients with chronic hepatitis B are variable. Whether resistant HBV strains are transmitted in the acute setting is uncertain. We sought to document the presence of antiviral resistance (AVR) mutations in patients with acute HBV (AHB) infection.. AHB infection was defined by HBsAg/IgM anti-HBc positivity, ALT>10X ULN and compatible clinical history. The TRUGENE HBV kit was used to perform genotyping and direct sequencing of the viral polymerase. INNO-LiPA HBV DRv2 and DRv3 were used to detect AVR mutations. Clonal sequencing was conducted on selected specimens.. Twenty-three patients were evaluated (mean age, 43 years; 54% male; 39% African American, 39% Caucasian, 13% Hispanic and 4% Asian). The mean peak ALT was 1554.2IU/L and mean peak total serum bilirubin was 12 mg/dl. The HBV DNA median viral load (N = 15) was 5.14 log(10)IU/ml. Nineteen patients were genotype A, and 1 each were genotype C, D, E and G. HBV drug resistance mutations were not detected by direct sequencing or INNO-LiPA. Clonal sequencing was conducted on 192 clones isolated from three patients and showed rtA181T, rtM250V and rtS202G mutations at an overall frequency of 1.54%, 1.39%, and 1.67% respectively.. We detected adefovir/lamivudine and entecavir relevant mutations in a minor population (<2%) of viral clones by clonal sequencing only. The clinical significance of these mutations is uncertain and may represent small populations of quasi-species vs. transmission of drug resistant strains.

Topics: Acute Disease; Adenine; Adult; Antiviral Agents; Cohort Studies; Cross-Sectional Studies; Drug Resistance, Viral; Female; Genotype; Guanine; Hepatitis B; Humans; Lamivudine; Male; Mutation; Organophosphonates; Retrospective Studies; Sequence Analysis, DNA; United States

Topics: Acute Disease; Antineoplastic Agents; Antiviral Agents; Cytarabine; Daunorubicin; Drug Therapy, Combination; Female; Guanine; Hepatitis B; Humans; Leukemia, Myeloid; Treatment Outcome; Young Adult

In most cases clinical profile of acute hyperlipidemic pancreatitis is a preexisting lipoprotein abnormality associated to second risk factors such as alcohol abuse, diabetes mellitus or medications that can induce hypertrygliceridemia. We report a case of a young male affected by chronic hepatitis B virus infection admitted to Emergency Department due to acute abdominal pain, vomiting and fever. The patient was in antiretroviral treatment with entecavir; moreover he was affected by diabetes mellitus and he presented a past history of alcohol abuse. Laboratory tests demonstrated hyperglycemia, severe metabolic acidosis and hypertriglyceridemia, whereas abdominal computed tomography scan revealed peripancreatic edema: hyperlipidemic pancreatitits was supposed and the patient was admitted to the intensive care unit. Considering its possible role in the pathogenesis of pancreatitis, entecavir was interrupted and total of 3 sections of plasmapheresis were performed, allowing clinical resolution and prevention of pancreatic damage. The possible pathogenetic role of entecavir is discussed.

Topics: Abdominal Pain; Acute Disease; Adenine; Adult; Alcoholism; Antiretroviral Therapy, Highly Active; Critical Care; Diabetes Mellitus, Type 2; Fever; Guanine; Hepatitis B, Chronic; Humans; Hyperlipidemias; Hypertriglyceridemia; Male; Organophosphonates; Pancreatitis; Plasmapheresis; Reverse Transcriptase Inhibitors; Tenofovir; Tomography, X-Ray Computed; Triglycerides

To explore the opportunity and effect of internal general treatment added entecavir on acute-on-chronic liver failure (ACLF) of HBeAg-negative chronic hepatitis B patients in different ranges of MELD score.. A total of 101 ACLF of HBeAg-negative chronic hepatitis B patients treated with internal general treatment added entecavir were divided into three groups according to the MELD score. The mortalities and HBV DNA loads during the initiation of therapy, recovery phase and in deathbed phase were studied.. 20 of patients with high MELD score (> or = 30) received (14.6 +/- 14.1) days treatment. The difference in MELD score between pre-(36.03 +/- 5.01) and post-treatment (39.86 +/- 5.95) was significant (t = - 2.994, P = 0.007). There was no significant difference in HBV DNA load between pre-[(4.454 +/- 1.714) copies log10/ml] and post-treatment [(3.979 +/- 1.947) copies log10/ml] (t = 2.212, P = 0.051), the mortality was 100% (20/20). 47 of patients with moderate MELD score (22-30) received (51.5 +/- 41.6) days treatment. There was no significant difference in MELD score between pre-(25.71 +/- 2.47) and post-treatment (26.18 +/- 13.32) (t = - 0.263, P = 0.794). The difference in MELD score between pre-[(6.084 +/- 1.795) copies log10/ml] and post-treatment [(3.378 +/- 2.156) copies log10/ml] was significant (t =7.148, P = 0.000), the mortality was 53.19% (25/47). 34 of patients with low MELD score (< or = 22) received (67.2 +/- 40.9) days treatment. The difference in MELD score was significant between pre-(< or = 18.85 +/- 2.72) and post-treatment (11.68 +/- 7.23) (t = 5.983, P = 0.000). There was significant difference in HBV DNA load between pre-[(5. 945 +/- 1.635) copies log10/ml] and post-treatment [(2.725 +/- 1.194) copies log10/ml] (t = 9.962, P = 0.000), the mortality was 2.94% (1/34).. The ACLF of HBeAg-negative chronic hepatitis B patients with a low score of MELD score (< or = 22) mostly survive with internal general treatment added entecavir. The mortality of the patients with a MELD score (22-30) is 53.19% (25/47). The patients with high MELD score (> or = 30) which almost lack the opportunity of treatment, is associated with fatal liver failure and need for emergency liver transplantation.

Topics: Acute Disease; Adult; Aged; Antiviral Agents; DNA, Viral; End Stage Liver Disease; Female; Guanine; Hepatitis B e Antigens; Humans; Male; Middle Aged; Severity of Illness Index

Topics: Acute Disease; Adult; Antiviral Agents; Guanine; Hepatitis B; Humans; Male

The efficiacy of Entecavir and Adefovir for treatment of acute hepatitis B is not known.. Two women with severe acute hepatitis B (HB) complained about a skin rash as well as jaundice, nonspecific epigastric and joint discomfort.. 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.. 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.. 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: www.gahb.de).

Topics: Acute Disease; Adenine; Adult; Algorithms; Antiviral Agents; Bilirubin; DNA, Viral; Drug Therapy, Combination; Female; Guanine; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Lamivudine; Liver; Middle Aged; Organophosphonates; Prothrombin Time; Transaminases; Treatment Failure; Treatment Outcome