title: Successful treatment with adefovir dipivoxil in a patient with fibrosing cholestatic hepatitis and lamivudine resistant hepatitis B virus.
abstract: Fibrosing cholestatic hepatitis (FCH) is a severe clinical and histological variant of hepatitis B virus (HBV) infection seen most commonly in the HBV infected allograft after liver transplantation. Without treatment, FCH is fatal, rapidly and universally. Remission has been reported with lamivudine but is associated with evolving resistance to lamivudine. Adefovir dipivoxil has recently been reported to be a potent and highly effective inhibitor of HBV replication in both wild-type and lamivudine resistant HBV infection. We report a case of FCH 15 months after liver transplantation for HBV related cirrhosis despite therapy with lamivudine and hepatitis B immunoglobulin (HBIg). Within two weeks of commencing treatment with adefovir dipivoxil 10 mg once daily, the patient had made a remarkable recovery with resolution of jaundice and normalisation of liver biochemistry. HBV DNA and hepatitis B e antigen were lost from serum subsequently and liver histology had improved at four months. This case report suggests firstly, that advanced FCH can be reversed and secondly, that addition of adefovir dipivoxil to lamivudine and HBIg may be an effective antiviral strategy.
authors.affiliation: Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Walsh
authors.forename: T
authors.initials: T
authors.lastname: Woodall
authors.forename: P
authors.initials: P
authors.lastname: Lamy
authors.forename: D G
authors.initials: DG
authors.lastname: Wight
authors.forename: S
authors.initials: S
authors.lastname: Bloor
authors.forename: G J
authors.initials: GJ
authors.lastname: Alexander
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use*; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood / Q000150:complications / Q000628:therapy; D063065:Organophosphonates; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil