Introduction. Reactivation of chronic hepatitis B virus (HBV) infection often
occurs in hepatitis B surface antigen (HBsAg) positive patients undergoing
immunosuppressive or chemotherapy, but can also occur in HBsAg negative,
anti-HB core positive patients. Treatment of HBV reactivation with lamivudin
results in favourable outcome in the majority of patients. The aim of the
authors was to show the effect of lamivudin therapy to HBV reactivation
caused by immunosuppressive therapy. Outline of Cases. The first patient was
a 35-year-old woman with chronic hepatitis B virus infection who underwent
prednisolone therapy for pulmonal sarcoidosis. Four months after the
beginning of the therapy she presented with jaundice and a significant
increase in serum aminotransferase level. Liver biopsy showed chronic viral B
hepatitis of strong activity in the stage of rapidly developed cirrhosis. The
patient was treated with lamivudine with slow reduction of prednisolone
doses, which resulted in full clinical and biochemical recovery. The second
patient was a 40-year-old HBsAg negative female with a previous history of
resolved acute B hepatitis who received chemotherapy for non-Hodgkin
lymphoma. After the third cycle of chemotherapy a significant increase in
aminotransferase level occurred, chemotherapy was discontinued, but
aminotransferase level still increased. At that moment she was found to be
HBsAg positive, and PCR analysis detected a high viral load. Lamivudine
treatment resulted in the patient?s recovery and allowed further
chemotherapy. Conclusion. In case of the reactivation of chronic HBV
infection during immunosuppressive therapy, it should be stopped and
antiviral therapy should be immediately initiated. The use of lamivudine
results in rapid suppression of serum HBV DNA, improves the outcome and
enables the continuation of immunosuppressive and chemotherapy.
Clinical Efficacy of Entecavir and Factors Predicting Long-Term Treatment Response in Nucleoside-Naïve Patients with Chronic Hepatitis B
