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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure
Digestive Diseases and Sciences, Volume 57, No. 5, Year 2012
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Description
Background and Aims The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. Methods The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. Results The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. Conclusions Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting. © 2012 Springer Science+Business Media, LLC.
Authors & Co-Authors
Dao, Doan Y.
United States, Dallas
Ut Southwestern Medical School
Ajmera, Veeral H.
United States, Dallas
Ut Southwestern Medical School
Lee, William Martens
United States, Dallas
Ut Southwestern Medical School
Seremba, Emmanuel
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Sanders, Corron M.
United States, Dallas
Ut Southwestern Medical School
Hynan, Linda S.
United States, Dallas
Ut Southwestern Medical Center
Statistics
Citations: 36
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1007/s10620-011-2013-3
ISSN:
01632116
e-ISSN:
15732568
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Cohort Study
Case-Control Study