Lamivudine treatment for Hepatitis B in dialysis population : Case reports and literature review

It is well known that chronic hepatitis B plays a detrimental role on survival in patients on long-term dialysis and after kidney trans- plantation. The advent of nucleos(t)ide analogues offers the oppor- tunity to change the natural history of hepatitis B in patients with chronic kidney disease. We report our experience on lamivudine use in two patients with HBV-related liver disease on long-term dialysis. At the beginning, both the patients were HBsAg positive and HBeAg positive with high viral load ; after long-term lamivu- dine therapy, clearance of HBV viremia from serum was observed in both. Raised aminotransferase levels fell into the normal range and one patient experienced clearance of HBsAg by anti-HBV therapy. Tolerance to lamivudine was satisfactory and lamivudine resistance was not detected. Information on antiviral therapy with lamivudine in HBsAg positive patients on regular dialysis is -extremely- limited-;- we- identified- by- an- extensive- review- of- the -literature- five- studies- with- a- total- of- 38- unique- patients,- most- of them being renal transplant candidates. Lamivudine proved to be effective as the clearance of HBV viraemia from serum ranged between 56% and 100% ; the clearance of HBeAg from serum was less-evident-(between-37.5%-and-100%).-No-significant-side-effects due to lamivudine were observed and emergence of lamivudine- resistant strains was observed in two (5%) patients. Only a minority of-patients-experienced-HBsAg-loss-(13%).-We-conclude-that-anti- HBV treatment with a nucleoside analogue such as lamivudine gives satisfactory results in some patients on long-term dialysis. Clinical- trials- are- in- progress- to- assess- efficacy- and- safety- of- last- generation nucleos(t)ide analogues for anti-HBV therapy in dialysis population. (Acta gastroenterol. belg., 2013, 76, 423-428).