The evaluation of de novo combination of antiviral treatment to hepatitis B patients with decompensated cirrhosis

Objective To evaluate the efficacy and safety of de novo combination therapy with lamivudine and adefovir dipivoxil in the treatment patients of chronic hepatitis B with decompensated cirrhosis.Methods Thirty chronic hepatitis B patients with decompensated cirrhosis were enrolled in and divided into two groups, one group (10 patients) was given lamivudine combined with adefovir dipivoxil at the beginning of the therapy, while the other group (control group) was given lamivudine only at the beginning of treatment, then added adefovir dipivoxil on after HBV YMDD mutation.The duration of treatment for both groups was 48 weeks.Results The ALT and TBil levels in these groups were improved after 4, 12, 24, and 48 treatment weeks (P<0.05) .No patient achieved HBV DNA undetectable in these groups after 4 and 12 weeks treatment.However, after 24 weeks treatment, 4 in denovo combination group (40%) and 4 in added-on group (20%) achieved HBV DNA undetectable, respectively (P=0.384) .The undetectable rates of HBV DNA at week 48 were 90% for the denovo combination group and 40% for the controls (P<0.05) .The rates of HBeAg/HBeAb seroconversion were 60% and 20% (P<0.05) , respectively for the denovo combination group and the control.After 48 weeks treatment, Child-Pugh scores in the denovo combination group was better than that in the control group (P<0.05) .Conclusion Lamivudine combined with adefovir dipivoxil at the beginning of the therapy was effective in improving liver function, antiviral effect and Child-Pugh score in chronic hepatitis B with decompensated cirrhosis patients.