Medsocium.com

Telehin D.1, Kondrat P.2, Tychka I.2, Abragamovych T.2, Antonenko S.3, Lulchuk M.3, Kryzhanska M.1, Kobryn T.1, Hritsko R.1 National Medical University of Lviv1, Lviv Regional Hospital2, Institute for the Research of the Epidemiology and Infections Diseases of Kyiv3 Background/aim: The fact of HBV-infection in patients with end-stage renal disease (ESRD) is common and ranges 20-30% in some eastern European countries. Schemes and effectiveness of treatment of chronic hepatitis B (CHB) in this cohort were not established. The aim of our study was to evaluate course of CHB at the patients with ESRD treated with Lamivudine in the hemodialysis department. Methods: 55 patients with HBV-related chronic liver disease and ESRD were studied: 28 males, 15 females. Mean age - 41 years. Median ALT was 98 IU/L, all of them HBV-DNA+. 72% patients were with wild-type, 28% with mutant HBV (HBeAg-negative). High virulence HBV was characterized by high level virus circulation (21,5%). 37 patients have taken Lamivudine in creatinine clearance depending doses (10-50 mg/day) during 24 weeks. Serum HBV-DNA was detected using a PCR by “Amplisens HBV” (>1000 cp/ml). Lamivudine resistance was presumed by virological and biochemical worsening during treatment. HCV-, HDV-superinfection was excluded. Results. At the end of treatment with Lamivudine 17 patients (46%) achieved HBV-DNA clearance. Decreasing of ALT was notified in 52%. HBeAg seroconversion took place in 19% of HBeAg-seropositive patients. Sustained virological response within 12 months after treatment was revealed in 13 patients (35%). In 4 patients (24% of responders) HBV reactivation was noted. Kidney transplantation was made in 12 patients with SVR. In this group 8 patients (66%) develop HBV reactivation within the first year after surgery. In 18 patients without Lamivudine therapy late chronic hepatitis B sequences were present: mild and average chronic liver disease – 28%, severe chronic liver disease and cirrhosis – 50%, fatal outcome in 22% of patients was due to chronic liver failure. In patients nonresponders and/or in those with HBV reactivation the late sequences rate was accordingly 55%, 45%, 0%. Conclusions: Peculiarities of clinical course and treatment in immunocompromised patients with end-stage renal disease strictly depend on the fact of HBV virulence. In this cohort sustained virological response (6 month duration Lamivudine therapy course) is 35%. In 66% kidney recipients reactivation of chronic hepatitis B is experienced even if surgery was after HBV disappearance. Severe course and mortality rate in Lamivudine treated patients, including those without confirmed virologic response were more rear then in non treated patients.