Browsing by Author "Herath, C.A."

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Lamivudine for hepatitis B infection in post-renal transplant patients: 36 month follow-up
(Wiley Blackwell Scientific Publications, 2004) de Silva, H.J.; Herath, C.A.; Sheriff, M.H.R.
INTRODUCTION: Therapy with interferon-alpha is inappropriate for post-renal transplant Hepatitis B infection, as it may result in graft rejection. We assessed the efficacy of lamivudine in HBV infection among post-renal transplant patients after 36 months of treatment. METHODS: From April 1999, post-renal transplant patients with chronic HBV infection were offered treatment with lamivudine 100 mg/day. Their liver function and HBV serology were assessed 3 monthly, and HBV-DNA annually or when otherwise indicated. Post-transplant immunosuppressive therapy was not altered. RESULTS: Lamivudine treatment was started in 43 patients [M:F = 28:15; median age 41 yrs (range 28–76)]. At recruitment, all were HBsAg (+), HBV-DNA (+) and anti-Hbe (-); 35 were HBeAg (+). Serum ALT was 24–768 IU/L (median 113). 6 had hepatic decompensation and 4 died (3 from renal causes) within one month of starting lamivudine. After 12 months of treatment HBV-DNA became undetectable and ALT normalised in 30/39 (76.9%). 16/30 discontinued treatment, but all 16 became HBV-DNA (+) 3 months later; lamivudine was restarted. 32 patients completed 36 months of treatment (7 lost to follow-up). All were HBsAg (+); 23 were HBVDNA (+) - 18/23 had earlier become DNA (-) with treatment but had breakthrough HBV-DNA (+), 5/23 were HBV-DNA(+) throughout follow-up; 4 patients were HBV-DNA (-), HBeAg (-), anti-Hbe (+); and 5 were HBV-DNA (-), HBeAg (-), anti-Hbe (-). There were no side-effects attributable to lamivudine. CONCLUSIONS: Lamivudine therapy suppressed HBV-DNA in postrenal transplant patients with HBV infection on immunosuppressive therapy, but suppression was dependant on continued therapy. After 36 months of treatment few patients showed HBe seroconversion, but not eradication of infection. Breakthrough HBV-DNA (+) occurred in a significant proportion during continued treatment
Lamivudine therapy for Hepatitis B (HBV) infection in post renal transplant patients: results after 12 months follow up
(Sri Lanka Medical Association, 2002) de Silva, H.J.; Sheriff, M.H.R.; Herath, C.A.
INTRODUCTION: The prevalence of HBV infection is high among renal transplant patients. Interferon-alpha (standard therapy), is inappropriate in this situation, as it is associated with an unacceptable risk of graft rejection. OBJECTIVE: Assess the efficacy of lamivudine in HBV infection among post-renal transplant patients. METHODS: Post-renal transplant patients with chronic (>6 months) HBV infection were recruited from April 1999. They were given lamivudine lOOmg/day. Their liver function and HBV serology were assessed 3 monthly, and HBV-DNA annually. Post-transplant immunosuppressive therapy was not altered. RESULTS: 28 patients [M:F=16:12; median age 41yrs (range 28-76)] have completed 12 months follow-up. At recruitment, they were all HBsAg(+), HBV-DNA(+) [median DNA level 3235 MEq/ml serum (range 359.3->4400], and anti-HBe(-); 25 were HBeAg(+). Serum ALT levels ranged from 33-768 IU/L (median 106). 3 patients had hepatic decompensation; 2 of them died within one month of starting lamivudine. At the end of 12 months, 26 were still alive. All were HBsAg(+); 4 (15.4%) had developed resistance to lamivudine (YMDD mutants); 3 had seroconverted [HBeAg(-), anti-HBe(+)]; 4 became HBeAg(-) but were still anti-HBe(-). There was reduction of HBV-DNA [median <0.7 MEq/ml serum (range<0.7-2072)] (p<0.01, Mann-Whitney U test), levels being undetectable (<0.7 MEq/ml) in 19 (73.1%). 8 of these 19 patients discontinued treatment; 3 months later HBV-DNA levels had become elevated in all 8 and HBeAg had reappeared in 4 who had also become HBeAg(-). CONCLUSIONS: Lamivudine therapy given over 12 months significantly reduces HBV-DNA load in post-renal transplant patients on immunosuppressive therapy, although the effect seems to be reversed on discontinuation of therapy. Full seroconversion is not common, and resistance to lamivudine occurs in a significant proportion after 12 months of treatment.
Lamivudine therapy for hepatitis B infection in post-renal transplant patients: results after 36 months follow-up
(Wiley-Blackwell, 2005) de Silva, H.J.; Herath, C.A.; Sheriff, M.H.
No Abstract Available