The impact of oral antiviral therapy on long-term survival of hepatitis B surface antigen-positive patients on haemodialysis.

Abstract

AIMS:

Hepatitis B (HBV) is an important cause of morbidity and mortality in end-stage renal disease patients. The effect of oral antiviral therapy on survival in this population is not known. We evaluated the impact of oral antivirals on survival of HBV-infected haemodialysis patients.

METHOD:

This retrospective study included 52 HBsAg-positive haemodialysis patients and 156 non-infected haemodialysis controls. Criteria adopted for starting lamivudine were the 2001 American Association for the Study of Liver Diseases guidelines. Lamivudine was commenced in 21 (40.4%) patients, with median treatment duration of 58 months. The primary endpoint was transplant-free survival.

RESULTS:

Survival of HBsAg-positive patients was equivalent to that of age- and sex-matched HBsAg-negative controls (39.1% vs 33.2% at 10 years, respectively; P=0.12). In treated patients, complete viral suppression was associated with improved survival (serial HBV DNA less than and equal to 2 log10 IU/mL, 90.9% vs HBV DNA >2 log10 IU/mL on at least one occasion, 74.1% at 5 years; P=0.049). Out of 20 deaths, three were liver-related.

CONCLUSION:

Haemodialysis patients with chronic HBV, when given oral antiviral therapy if indicated, had equivalent long-term survival to that of non-infected controls. In those with active viral hepatitis, viral suppression was associated with reduced liver-related mortality.

• Authors: Maggie M G Ow, Janak R de Zoysa, Edward J Gane
• Journal: The New Zealand medical journal (N Z Med J) Vol. 127 Issue 1396 Pg. 34-42 (Jun 20 2014) ISSN: 1175-8716 [Electronic] New Zealand
• PMID: 24997462 (Publication Type: Journal Article)

Chemical References

• Hepatitis B Surface Antigens
• Reverse Transcriptase Inhibitors
• Lamivudine

Topics

• Administration, Oral
• Aged
• Female
• Hepatitis B (complications, drug therapy)
• Hepatitis B Surface Antigens (blood)
• Humans
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (complications, therapy)
• Kidney Transplantation
• Lamivudine (therapeutic use)
• Male
• Middle Aged
• Proportional Hazards Models
• Renal Dialysis
• Retrospective Studies
• Reverse Transcriptase Inhibitors (therapeutic use)
• Survivors