Abstract
Acute infection with the hepatitis B virus resolves in 95% of adults with no need for specific medical therapy. However, a few cases present as severe hepatitis or acute liver failure, which may require orthotopic liver transplantation or cause death. Under these circumstances, medical therapy that can improve the clinical outcome and improve spontaneous survival would be highly useful; yet, published data regarding the utility of antiviral therapy in acute hepatitis B is quite limited. In this paper, the efficacy and safety of oral nucleoside and nucleotide analogues in the treatment of acute hepatitis B are reviewed, and guidelines for treatment of these acute cases are revisited.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Daniels D, Grytdal S, Wasley A; Centers for Disease Control and Prevention (CDC): Surveillance for acute viral hepatitis—United States, 2007. MMWR Surveill Summ 2009, 58(3):1–27.
Schiødt FV, Davern TJ, Shakil AO, et al.: Viral hepatitis-related acute liver failure. Am J Gastroenterol 2003, 98:448–453.
Tassopoulos NC, Koutelou MG, Polychronaki H, et al.: Recombinant interferon-alpha therapy for acute hepatitis B: a randomized, double-blind, placebo-controlled trial. J Viral Hepat 1997, 4:387–394.
Kundu SS, Kundu AK, Pal NK: Interferon-alpha in the treatment of acute prolonged hepatitis B virus infection. J Assoc Physicians India 2000, 48:671–673.
Flink HJ, Sprengers D, Hansen BE, et al.: Flares in chronic hepatitis B patients induced by the host or the virus? Relation to treatment response during Peg-interferon {alpha}-2b therapy. Gut 2005, 54:1604–1609.
Perrillo RP: Acute flares in chronic hepatitis B: the natural and unnatural history of an immunologically mediated liver disease. Gastroenterology 2001, 120:1009–1022.
Baumert TF, Thimme R, von Weizsäcker F: Pathogenesis of hepatitis B virus infection. World J Gastroenterol 2007, 13:82–90.
Leifeld L, Cheng S, Ramakers J, et al.: Imbalanced intrahepatic expression of interleukin 12, interferon gamma, and interleukin 10 in fulminant hepatitis B. Hepatology 2002, 36:1001–1008.
Hoofnagle JH, di Bisceglie AM: The treatment of chronic viral hepatitis. N Engl J Med 1997, 336:347–356.
Manns MP: Current state of interferon therapy in the treatment of chronic hepatitis B. Semin Liver Dis 2002, 22(Suppl 1):7–13.
Lok AS, Lai CL, Leung N, et al.: Long-term safety of lamivudine treatment in patients with chronic hepatitis B. Gastroenterology 2003, 125:1714–1722.
Reshef R, Sbeit W, Tur-Kaspa R: Lamivudine in the treatment of acute hepatitis B. N Engl J Med 2000, 343:1123–1124.
Chalupa P, Holub M: Favorable outcome of severe acute hepatitis B in a patient treated with antithrombin III and antiviral therapy. Clin Infect Dis 2009, 49:481.
Torii N, Hasegawa K, Ogawa M, et al.: Effectiveness and long-term outcome of lamivudine therapy for acute hepatitis B. Hepatol Res 2002, 24:34.
Kondili LA, Osman H, Mutimer D: The use of lamivudine for patients with acute hepatitis B (a series of cases). J Viral Hepat 2004, 11:427–431.
Petrelli E, Balducci M, Pieretti C, et al.: Lamivudine treatment failure in preventing fatal outcome of de novo severe acute hepatitis B in patients with haematological diseases. J Hepatol 2001, 35:823–826.
Wang YC, Kuo MC, Hung CC, et al.: Lamivudine reverses severe acute hepatitis B and pancytopenia after renal transplantation: a case report. Transplant Proc 2006, 38:3125–3127.
Haznedar R, Yağci M.: Lamivudine therapy for acute hepatitis B infection following peripheral blood stem cell transplantation. Am J Hematol 2002, 69:151.
Nakhoul F, Gelman R, Green J, et al.: Lamivudine therapy for severe acute hepatitis B virus infection after renal transplantation: case report and literature review. Transplant Proc 2001, 33:2948–2949.
Andreone P, Caraceni P, Grazi GL, et al.: Lamivudine treatment for acute hepatitis B after liver transplantation. J Hepatol 1998, 29:985–989.
Efremov DG, Georgievski B, Cevreska L, et al.: Lamivudine treatment for acute hepatitis B virus infection during allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 2003, 31:515–516.
Dulai G, Higa L, Kobashigawa J, Martin P: Successful use of lamivudine for severe acute hepatitis B virus infection in a cardiac transplant recipient. Transplantation 1999, 67:1288–1289.
Gupta S, Piraka C, Jaffe M: Lamivudine in the treatment of polyarteritis nodosa associated with acute hepatitis B. N Engl J Med 2001, 344:1645–1646.
Di Marco V, De Lisi S, Li Vecchi M, et al.: Therapy with lamivudine and steroids in a patient with acute hepatitis B and rapidly progressive glomerulonephritis. Kidney Int 2006, 70:1187–1188.
Miyake Y, Iwasaki Y, Takaki A, et al.: Lamivudine treatment improves the prognosis of fulminant hepatitis B. Intern Med 2008, 47:1293–1299.
Lisotti A, Azzaroli F, Buonfiglioli F, et al.: Lamivudine treatment for severe acute HBV hepatitis. Int J Med Sci 2008, 5:309–312.
Delic D, Nesic Z, Prostran M, et al.: Treatment of subacute hepatitis B with lamivudine: a pilot study in Serbia. Vojnosanit Pregl 2009, 66:199–202.
Schmilovitz-Weiss H, Ben-Ari Z, Sikuler E, et al.: Lamivudine treatment for acute severe hepatitis B: a pilot study (published erratum appears in Liver Int 2004, 24:547–551). Liver Int 2004, 24:547–551.
Tillmann HL, Hadem J, Leifeld L, et al.: Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience. J Viral Hepat 2006, 13:256–263.
• Kumar M, Satapathy S, Monga R, et al.: A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology 2007, 45:97–101. This article describes the largest prospective study that evaluated lamivudine therapy in acute hepatitis B, with other larger studies being references 28 and 29.
Girke J, Wedemeyer H, Wiegand J, et al.: Acute hepatitis B: is antiviral therapy indicated? Two case reports [article in German]. Dtsch Med Wochnschr 2008, 133:1178–1182.
• Palumbo E: Entecavir for chronic hepatitis B: a review. Ther Drug Monit 2008, 30:1–4. This article is a comprehensive review of entecavir, its safety and efficacy, as a treatment for hepatitis B.
• Lange CM, Bojunga J, Hofmann WP, et al.: Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology 2009, 50:2001–2006. This article is a report of severe lactic acidosis in a case series of patients with hepatitis B cirrhosis and significantly impaired liver function while on entecavir therapy.
•• Lok AS, McMahon BJ: Chronic hepatitis B: update 2009. Hepatology 2009, 50:661–662. This article is an updated set of practice guidelines that provide a comprehensive guide to the management of hepatitis B in various populations.
Disclosure
No potential conflict of interest relevant to this article was reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Te, H.S. Treatment of Acute Hepatitis B with Nucleoside and/or Nucleotide Analogues. Curr Hepatitis Rep 9, 119–123 (2010). https://doi.org/10.1007/s11901-010-0033-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11901-010-0033-7