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Gut 49:436-440 doi:10.1136/gut.49.3.436
  • Case report

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.

Footnotes

  • Abbreviations used in this paper:
    HBV
    hepatitis B virus
    HBIg
    hepatitis B immunoglobulin
    HBeAg
    hepatitis B e antigen
    FCH
    fibrosing cholestatic hepatitis
    HBsAg
    hepatitis B surface antigen
    HBcAg
    hepatitis B core antigen
    anti-HBe
    antibody to hepatitis B e antigen
    HDV
    hepatitis D virus
    anti-HBs
    antibody to hepatitis B surface antigen
    ALT
    alanine aminotransferase
    RT
    reverse transcriptase