Entecavir treatment for chronic hepatitis B infection in end-stage renal disease and kidney transplantation

Abstract

BACKGROUND: The prevalence of chronic hepatitis B virus (HBV) infection is high in patients with end-stage renal disease and in kidney transplant recipients, and there is little experience with treatment using the newer antiviral drugs. The aim of this study was to assess the efficacy and safety of entecavir in HBV infection in this difficult-to-treat population. METHODS: Eleven male patients - 1 with stage 4 chronic kidney disease, 7 undergoing hemodialysis, and 3 kidney transplant recipients - were included in the study evaluation. Six were treatment naïve, and 5 were lamivudine resistant. Entecavir was administered at a dose of 0.1-1 mg qd according to the patients' renal function. All were HBsAg positive: 9 were HBeAg (+)/antiHBe (-), and the remaining 2 were HBeAg (-)/antiHBe (+). RESULTS: After a median treatment of 2 ± 0.86 years, entecavir therapy was associated with a significant decrease in HBV DNA viral load: it was 6.84 ± 1.45 log10 UI/mL (range 5.21-9.04) at baseline and at the time of evaluation had dropped to 1.73 ± 2.11 log10 UI/mL (range <0.78-4.72). The rate of HBV DNA clearance was 54.5% (n = 6). The rate of anti-HBe seroconversion was 77.7% (7/9 HBeAg-positive patients). The rate of anti-HBs seroconversion was 9.1% (1/11 patients). There were no significant changes in renal function or hematological parameters. CONCLUSIONS: This small study demonstrates that entecavir therapy is safe and efficient in HBV-positive patients with varying degrees of renal dysfunction.