Liver failure: People dying from liver failure caused by hepatitis B in the 1990s had no options. Liver transplantation was not successful because uncontrolled hepatitis B quickly destroyed the new liver. Interferon treatment was dangerous in people who were already very sick. Lamivudine changed everything in the late 1990s. Many of the people with liver failure got better with Lamivudine treatment without needing liver transplant. Indeed, many of these people are still seen in our clinic in 2008, doing fine without any signs of liver failure. Although Lamivudine at first looked like the miracle drug for hepatitis B, its Achilles heel came to light a few years later when the drug failed because of drug resistance. That is, the hepatitis B virus adapted and changed in such a way that Lamivudine could no longer control that new strain of hepatitis B. When the virus came back, the liver injury returned. Fortunately, there are newer medications now available that can deal with these adapted viruses. For mroe information on hepatitis B treatment, click here.


Cirrhosis/Advanced liver fibrosis with high viral load: Treatment of cirrhotics is good - click for the big picture A large study of hepatitis B patients with advanced liver disease and yet were still asymptomatic has shown that Lamivudine can prevent the complications of liver failure and liver cancer. Everyone in this study had a liver biopsy showing either cirrhosis (F4) or were close to cirrhosis (F3). Furthermore, everyone had high viral load over 0.7 MEq/mL, which is about 130,000 IU/mL or 5.1 log IU/mL. The study was stopped after about 32 months because it was clear that those who received placebo (no active drug) had higher rates of liver failure and liver cancer. When they looked at their results more closely, they also realized that those who had Lamivudine but had developed drug failure from resistance did not do as well as those who were still responding to lamivudine (see graph).


Weakened immune system. People taking medicines such as chemotherapy, drugs for transplantation, treatment of arthritis, treatment of inflammatory bowel disease etc. should also have treatment to keep hepatitis B under control while the immune system is down. This is true even if their immune system had previously controlled hepatitis B to low HBV viral loads.


Everyone else needs to be considered on an individual basis. Many factors have to be weighed as it is still not clear that treatment of people without significant liver damage (scarring) is of benefit. Talk to your liver specialist.

When you are ready, you can move on to learn about how to prevent the spread of hepatitis B.