Introduction Acute hepatitis B in adults is successfully cleared in more than 95% of immunocompetent patients. A small proportion of patients develop fulminant hepatitis. Few controlled trials1 2 have evaluated the role of antivirals in patients with acute severe hepatitis B (AS-HBV). The aim of this study was to report our experience of AS-HBV management at a tertiary centre.
Methods We retrospectively identified all patients between August 2006 and August 2011, referred to our centre with acute HBV infection (diagnosis based on recent onset of jaundice, detection of serum HBsAg and IgM HBcAb). 1-Year data following the diagnosis was collected using medical and electronic records. We identified all patients meeting at least one of the three criteria for AS-HBV1 that is, INR ≥1.6, serum bilirubin ≥170 μmol/l and hepatic encephalopathy. Patients with other causes of acute liver injury such as alcohol and drugs were excluded.
Results 98 patients with acute HBV were identified during the study period. Of these, 64 (65.3%) patients had milder episodes. Thirty-four patients (34.7%; mean age 32, 50% females) had evidence of AS-HBV. Out of these, 17 (50%) patients had a bilirubin ≥170 μmol/l and 3 (8.8%) patients had INR ≥1.6 while 14 (41%) patients had both. None of the AS-HBV patients had evidence of encephlopathy. All patients had normal ultrasound scans of the liver and negative non-invasive liver screen, at the time of diagnosis. Of the 34 patients with AS-HBV, 20 (59%) patients received treatment with antiviral drugs, 55% with newer agents (Entecavir or Tenofovir) and 45% with older agents (Lamivudine or Adefovir). None of the patients developed any side effects to antiviral drugs. The remaining 14 (41%) patients with AS- HBV received supportive care only. There were no deaths or need for liver transplantation in either group.
Conclusion Acute hepatitis B usually runs a benign course but a proportion of patients can develop severe disease. Patients with acute severe hepatitis B may be safely treated with anti-viral drugs. Randomised controlled studies with newer antiviral agents are required to establish guidelines in treating patients with acute severe hepatitis B.
Competing interests None declared.
References 1. Schmilovitz-Weiss H, et al. Lamivudine treatment for acute severe hepatitis B: a pilot study. Liver Int 2004;24:547–51.
2. Kumar M, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology 2007;45:97–101.