Effects of Lamivudine on Serum Albumin Levels Correlate With Pretreatment HBV-DN

[Guest guest]

http://www.medscape.com/viewarticle/559751

--------------------------------------------------------------------------------

Effects of Lamivudine on Serum Albumin Levels Correlate With Pretreatment

HBV-DNA Levels in Cirrhotic Patients

Makoto Nakamuta;1 Kazuhiro Kotoh;1 Munechika Enjoji;1 Eiji Kajiwara;3 Junya

Shimono;4 Akihide Masumoto;5 Toshihiro Maruyama;6 Norihiro Furusyo;7

Hideyuki Nomura;8 Hironori Sakai;9 Kazuhiro Takahashi;10 Koichi Azuma;11

Shinji Shimoda;12 Yuichi Tanabe;2 Jun Hayashi7

Comparative Hepatology. 2007; ©2007 Nakamuta et al; licensee BioMed Central

Ltd.

This is an Open Access article distributed under the terms of the Creative

Commons Attribution License (http://creativecommons.org/licenses/by/2.0),

which permits unrestricted use, distribution, and reproduction in any

medium, provided the original work is properly cited.

Posted 07/24/2007

Abstract and Background

Abstract

Background. Lamivudine treatment has been recently demonstrated to increase

the serum albumin levels in cirrhotic patients with hepatitis B virus (HBV)

infection, but the precise mechanism remains unclear. We hypothesized that

the improvement of hypoalbuminemia by lamivudine may be attributable to the

reduction of HBV replication itself, rather than to cessation of hepatitis.

In order to confirm this hypothesis, in this study we evaluated factors

which correlated with the increase in serum albumin levels. Fifty-four

patients (Child-Pugh A/B/C, 35/9/10) with HBV-related liver cirrhosis who

had been treated with lamivudine for more than 12 months were evaluated. We

analyzed the correlation between the increase in serum albumin levels at

month 12 after starting treatment (Ä-albumin) and various pretreatment

variables. We also analyzed the correlation between Ä-albumin and the

reduction in serum levels of HBV-DNA (Ä-HBV-DNA) or alanine aminotransferase

(Ä-ALT) at month 12.

Results. The average Ä-albumin was 0.38 g/dL and only serum HBV-DNA levels

before treatment correlated significantly with Ä-albumin. We also analyzed

the correlation in patients whose alanine aminotransferase levels were

normalized after 12 months so that the possible influence of breakthrough

hepatitis could be excluded. Even among this subgroup of patients, there was

no significant correlation between Ä-albumin and either pretreatment alanine

aminotransferase levels or Ä-ALT. In contrast, in patients whose serum

HBV-DNA was undetectable at month 12, we found a significant correlation

between Ä-albumin and both pretreatment serum HBV-DNA levels and Ä-HBV-DNA.

Conclusion. Our results demonstrated that albumin levels are associated with

pretreatment HBV-DNA but not with alanine aminotransferase levels.

Background

Chronic hepatitis B is an important cause of morbidity and mortality

resulting from cirrhosis-related liver failure and hepatocelluar carcinoma

(HCC).[1-3] Lamivudine, a nucleoside analogue with potent antiviral effects

against hepatitis B virus (HBV), has been shown to be effective both in

patients with chronic hepatitis and also those with liver cirrhosis.[4-6] In

cirrhotic patients, decreased HBV-DNA loads following lamivudine treatment

result in decreased serum levels of alanine aminotransferase (ALT),

increased serum albumin levels, and improvement of the Child-Pugh

score.[7-13] The underlying mechanism for the increase in albumin levels

after lamivudine treatment has not been determined. It has been suggested

that the improvement of hypoalbuminemia may be attributable to the cessation

of hepatic inflammation. However, earlier treatments such as glycyrrhizin,

ursodeoxycholic acid,[14,15] predonisolone,[16] and Stronger Neo-Minophagen

C therapy,[17] all of which reduce ALT levels in viral cirrhotic patients,

do not result in improvement of hypoalbuminemia. Furthermore, it has been

shown that there is no significant correlation between serum ALT levels and

HBV-DNA loads in patients with HBV.[18-20] We hypothesized that the

improvement of hypoalbuminemia by lamivudine may be attributable to the

reduction of HBV replication itself, rather than to cessation of hepatitis.

In order to confirm this hypothesis, we evaluated several laboratory

parameters in cirrhotic patients treated with lamivudine that could

influence serum albumin levels.

_________________________________________________________________

http://liveearth.msn.com