Entecavir Treatment For Patients With Decompensated Cirrhosis Resulting From Chronic Hepatitis B

Objective: To evaluate the efficacy and safety of entecavir (ETV) treatment for patientswith decompensated cirrhosis resulting from chronic hepatitis B.Patients and Methods: The trial design was an open prospective study. We consecutivelyenrolled41patients with decompensated cirrhosis resulting from chronic hepatitis B, inwhich all were positive for HBV-DNA in serum,23(56.1%) were HBeAg positive,39hadascites,26had Child-Pugh class B and15had Child-Pugh class C liver disease. All patientshave been treated with ETV0.5mg orally once daily for9-60months (median time23months). The follow-up was done in the first month and the third month, then every3months thereafter. The evaluation included clinical symptoms, hepatic function tests,HBV-DNA in serum and ultrasound examination of ascites.Results: ETV significantly improved liver function, with a87.8%of normalization ofserum ALT, a decrease in serum bilirubin from43.9±29.4μmol/L to22.9±14.3μmol/L（p<0.001）, an increase in serum albumin from29.2±7.1g/L to37.7±6.8g/L (p<0.001,baseline vs last visit), and a decrease in Child-Pugh score from9.2±1.9to5.9±0.9(p<0.001).80.5%(33/41) of patients became Child-Pugh class A and90.2%(37/41)showed the improvement in the Child-Pugh score more than2points. ETV rapidly reducedHBV-DNA in serum to undetectable levels, the cumulative rate of HBV DNA negativitywas92.7%, in which the cumulative rate of HBV DNA negativity was100%in18HBeAg-negative patients and86.9%in23HBeAg-positive patients (p=0.003), thecumulative rate of HBeAg seroconversion was39.1%. In a majority of these41cases, clinical symptoms such as abdominal distension, fatigue and inappetence gradually andmarked improved, and ascites was disappeared in39of41patients. During the follow-upperiod, no patients died and2patients developed hepatocellular carcinoma. ETV was welltolerated with no serious side effects and only7patients had mild discomfort such asdizziness and nausea.Conclusion: ETV fleetly inhibits viral replication of hepatitis B and results in a significantimprovement of liver function in patients with decompensated HBV cirrhosis, and mayprevent the progress of the disease.