In the lamivudine treatment group there were 12 HBeAg-negative patients, and seroconversion of HBeAg occurred in 11 of 26 patients, in which one patient lost hepatitis B HBsAg; whereas in the control group there were nine HBeAg-negative patients, AUY-922 in vivo and seroconversion of HBeAg occurred in two of nine patients, and none of the patients lost HBsAg. No patients showed evidence of YMDD mutations at baseline. No clinical evidence of drug-resistant mutants was detected during the 3-month lamivudine treatment in the survivors. No serious adverse event that could be attributed to lamivudine occurred, and all the patients tolerated

the therapy without dose modification or early discontinuation. No pancreatitis, neuropathy or renal impairment occurred in these patients. Acute-on-chronic hepatic failure is a serious condition with varied etiology and manifestations, as well as high mortality. Among the infectious etiologies, HBV infection is one of the major causes of ACLF in Asia. The pathogenesis of ACLF caused by HBV remains incompletely understood. A ‘two-hit’ hypothesis may be proposed to explain the pathogenesis of acute-on-chronic

hepatitis B liver failure. The first hit is considered to be a primary injury caused directly or indirectly by HBV, and the other is a cytokine-cored this website secondary lesion. HBV replication is one of the key factors causing the progression of severe liver damage

to liver failure. Long-term follow-up studies have demonstrated the close relationship between disease severity and viral factors.15 Early antiviral treatment shortens and improves the symptomatic phase of infection and allows a ready clinical and biochemical improvement. Lamivudine, an oral cytosine nucleoside analog clinically used for the treatment of chronic HBV infection, which can produce marked viral suppression, reduction of hepatic necroinflammatory activity, histological improvement of liver fibrosis16 and improved liver function,17 even in patients with decompensation.18 Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B.11,19 However, the experience with lamivudine for the treatment of patients with ACLF induced by HBV 上海皓元 is limited. Wang et al.20 conducted a large retrospective study of 1036 patients with HBV-associated hepatic failure which demonstrated that the percentage of patients that recovered or had improved outcomes was significantly higher in those who received lamivudine therapy compared with those who did not. They also found that the outcome would be better if the patients were treated early with nucleoside analog. Our study showed that lamivudine treatment significantly decreased the mortality of patients with a MELD score of 20–30, but had no effect on patients with a MELD score of more than 30.