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Nucleoside Analogue Can Improve the Long-Term Prognosis of Patients with Hepatitis B Virus Infection-Associated Acute on Chronic Liver Failure

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Abstract

Background

The prognosis of patients with hepatitis B virus (HBV)-associated acute on chronic liver failure (ACLF) is extremely poor.

Aim

This study was designed to evaluate the efficacy and safety of nucleoside analogue treatment of patients with HBV-associated ACLF.

Methods

We used a retrospective review of eligible patients from April 2006 to December 2008. Eligible subjects received 0.5 mg entecavir daily until October 2009 (group A), 100 mg lamivudine daily until October 2009 (group B), or no nucleoside analogue (group C). The primary endpoints were three-month survival and the rate of recurrence of HBV-associated ACLF. The secondary endpoints were HBV DNA levels, liver function, the model of end-stage liver disease (MELD) score, and adverse events.

Results

A total of 104 consecutive patients were recruited, and 33, 34, and 37 patients were randomly allocated to groups A, B, and C, respectively. Although no significant difference in three-month survival was observed, levels of HBV DNA and rates of recurrence of HBV-associated ACLF were lower. Liver function and MELD score were not significantly improved despite significantly reduced HBV DNA levels.

Conclusions

These data indicated that nucleoside analogue treatment did not improve the short-term prognosis of patients with HBV-associated ACLF although it was efficacious and safe in the management of HBV DNA levels. Intriguingly and importantly, continuous nucleoside analogue treatment can significantly reduce the rate of recurrence, which might be indicative of the further benefit of long-term survival.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (No. 30972622) and the National Basic Research Program of China (Nos 2007CB512902 and 2006CB504302). We are indebted to all colleagues and nurses at the Center of Infectious Disease and Intensive Care Unit of our hospital who took care of these patients. We particular thank Professor George M. Davis, Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, for his valuable scientific suggestions and language editing of this manuscript and Dr Mao-Bin Meng, Division of Thoracic Cancer, Cancer Center, West China Hospital, Sichuan University, for valuable scientific suggestions. We also thank an anonymous referee for his/her very helpful comments, which remarkably improved the quality of this paper.

Conflict of interest statement

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Center of Infectious Diseases, West China Hospital, West China School of Medicine, Sichuan University, 37# Guoxue Lane, 610041, Chengdu, China

    Yao-Li Cui, Fang Yan, Yue-Bin Wang, Xue-Qin Song, Li Liu, Xue-Zhong Lei, Hong Tang & Ping Feng

  2. Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China

    Ming-Hua Zheng

  3. Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China

    Yao-Li Cui, Fang Yan, Yue-Bin Wang, Xue-Qin Song, Li Liu, Xue-Zhong Lei, Hong Tang & Ping Feng

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  1. Yao-Li Cui
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  2. Fang Yan
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Correspondence to Hong Tang or Ping Feng.

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Cui, YL., Yan, F., Wang, YB. et al. Nucleoside Analogue Can Improve the Long-Term Prognosis of Patients with Hepatitis B Virus Infection-Associated Acute on Chronic Liver Failure. Dig Dis Sci 55, 2373–2380 (2010). https://doi.org/10.1007/s10620-010-1257-7

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  • DOI: https://doi.org/10.1007/s10620-010-1257-7

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