Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension

[Guest guest]

Journal of Hepatology

Volume 51, Issue 3, September 2009, Pages 468-474

doi:10.1016/j.jhep.2009.05.031

European Association for the Study of the Liver Published by

Elsevier Ireland Ltd.

Antiviral therapy reduces portal pressure in patients with cirrhosis due to

HBeAg-negative chronic hepatitis B and significant portal hypertension

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

Spilios Manolakopoulos1, 2, , , , Christos Triantos3, 4, Jiannis

Theodoropoulos3, Jiannis Vlachogiannakos3, Anastasios Kougioumtzan3,

Papatheodoridis2, Dimitrios Tzourmakliotis1, Dimitrios Karamanolis3, K.

Burroughs4, Athanasios Archimandritis2, Sotirios Raptis5 and Alec Avgerinos3, †

1Department of Gastroenterology, Polyclinic General Hospital, Athens, Greece

22nd Department of Internal Medicine, University of Athens Medical School,

Athens, Greece

32nd Department of Gastroenterology, Evangelismos General Hospital, Athens,

Greece

4The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, London,

UK

52nd Department of Internal Medicine, Propedeutic, University of Athens Medical

School, Athens, Greece

Associate Editor: J. Bosch. Available online 3 July 2009.

Background/Aims

Lamivudine improves liver histology in patients with chronic hepatitis B (CHB),

but its effects on portal pressure remain unknown. We evaluated the effect of

lamivudine monotherapy on hepatic venous pressure gradient (HVPG) in CHB-related

cirrhosis with significant portal hypertension.

Methods

We studied 19 patients with cirrhosis due to HBeAg-negative CHB and HVPG 10 mm

Hg treated with oral lamivudine (100 mg daily). Liver biochemistry, Child-Pugh

and MELD score were determined every 3 months, alpha-fetoprotein and HBV DNA

every 6 months and HVPG at baseline and at 12 months after lamivudine

initiation. Diuretics, beta-blockers, antibiotics and/or endoscopic therapy were

used for routine indications.

Results

At 12 months, a significant reduction was observed in ALT (p = 0.001), HBV DNA

(p = 0.002), Child-Pugh (p = 0.012) and MELD score (p = 0.006). Four patients

developed virological breakthrough during treatment. At 12 months, HVPG

decreased in all but one patient [baseline: 14.4 ± 3.9 and 12 months: 12.4 ± 3.3

mm Hg (p = 0.007)]. HVPG decreased>20% or below the 12 mm Hg threshold in 10 of

13 patients with baseline HVPG 12 mm Hg. HVPG increased in a patient with

hepatic flare after virological breakthrough.

Conclusion

In conclusion, in patients with cirrhosis due to HBeAg-negative CHB, lamivudine

monotherapy reduces HVPG, especially when virological suppression and

biochemical remission is achieved.

[Guest guest]

Journal of Hepatology

Volume 51, Issue 3, September 2009, Pages 468-474

doi:10.1016/j.jhep.2009.05.031

European Association for the Study of the Liver Published by

Elsevier Ireland Ltd.

Antiviral therapy reduces portal pressure in patients with cirrhosis due to

HBeAg-negative chronic hepatitis B and significant portal hypertension

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

Spilios Manolakopoulos1, 2, , , , Christos Triantos3, 4, Jiannis

Theodoropoulos3, Jiannis Vlachogiannakos3, Anastasios Kougioumtzan3,

Papatheodoridis2, Dimitrios Tzourmakliotis1, Dimitrios Karamanolis3, K.

Burroughs4, Athanasios Archimandritis2, Sotirios Raptis5 and Alec Avgerinos3, †

1Department of Gastroenterology, Polyclinic General Hospital, Athens, Greece

22nd Department of Internal Medicine, University of Athens Medical School,

Athens, Greece

32nd Department of Gastroenterology, Evangelismos General Hospital, Athens,

Greece

4The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, London,

UK

52nd Department of Internal Medicine, Propedeutic, University of Athens Medical

School, Athens, Greece

Associate Editor: J. Bosch. Available online 3 July 2009.

Background/Aims

Lamivudine improves liver histology in patients with chronic hepatitis B (CHB),

but its effects on portal pressure remain unknown. We evaluated the effect of

lamivudine monotherapy on hepatic venous pressure gradient (HVPG) in CHB-related

cirrhosis with significant portal hypertension.

Methods

We studied 19 patients with cirrhosis due to HBeAg-negative CHB and HVPG 10 mm

Hg treated with oral lamivudine (100 mg daily). Liver biochemistry, Child-Pugh

and MELD score were determined every 3 months, alpha-fetoprotein and HBV DNA

every 6 months and HVPG at baseline and at 12 months after lamivudine

initiation. Diuretics, beta-blockers, antibiotics and/or endoscopic therapy were

used for routine indications.

Results

At 12 months, a significant reduction was observed in ALT (p = 0.001), HBV DNA

(p = 0.002), Child-Pugh (p = 0.012) and MELD score (p = 0.006). Four patients

developed virological breakthrough during treatment. At 12 months, HVPG

decreased in all but one patient [baseline: 14.4 ± 3.9 and 12 months: 12.4 ± 3.3

mm Hg (p = 0.007)]. HVPG decreased>20% or below the 12 mm Hg threshold in 10 of

13 patients with baseline HVPG 12 mm Hg. HVPG increased in a patient with

hepatic flare after virological breakthrough.

Conclusion

In conclusion, in patients with cirrhosis due to HBeAg-negative CHB, lamivudine

monotherapy reduces HVPG, especially when virological suppression and

biochemical remission is achieved.