Adefovir dipivoxil-induced development of osteomalacia and Fanconi syndrome during the treatment of hepatitis B virus (HBV)-related cirrhosis

Abstract

A 55-year-old man (height = 175 cm, weight = 68 kg, Body Mass Index = 22.2 kg/ m 2 ) came to our observation in December 2012 due to the onset of bone pain, muscle cramps, and asthenia. Past history revealed that about 24 years before (1988) a chronic hepatitis B (anti-HBe positive) infection was diagnosed and 15 years later (2003) liver biopsy and endoscopy documented the presence of cirrhosis (Child 5A) with esophageal varices, respectively.On 2005, a treatment with pegylated interferon (180 µg/week subcutaneously) was started (HBV-DNA = 10,000,000 IU/ml), but 18 months later (February 2007) for the persistence of high HBV-DNA levels (HBV-DNA = 352,000 IU/ml), pegylat- Why we describe this caseNotwithstanding adefovir is considered safe at the dosage of 10 mg/day, renal function must be carefully evaluated in order to prevent systemic disease and bone fracture. This case report could be useful in order to perform an appropriate prescription in HBV patients treated with adefovir and a risk of kidney or bone disease (e.g. patients taking non steroidal antinflammatory drugs, aminoglycosides, corticosteroids or menopausal women) ed-interferon was stopped and lamivudine (100 mg/day) was administered. During the follow-up, three months later ( Rate before adefovir = 78.26 ml/min/1.73 m 2 ; during adefovir treatment = 57.38 ml/min/1.73 m 2 ) Abstract Adefovir dipivoxil is a nucleotide analog reverse transcriptase inhibitor used to treat adult patients affected by HBeAg-positive and HBeAg-negative chronic hepatitis B and with clinical evidence of lamivudine-resistant hepatitis B virus (HBV). Adefovir administered at a dosage of 10 mg/day is generally well tolerated, even if renal toxicity, type Fanconi syndrome, was reported during long-term treatments. We report a case of osteomalacia with Fanconi syndrome and pathologic fracture of the femur related to long-time (67 months) adefovir treatment (10 mg/day) in a patient with compensated hepatitis B virus (HBV) cirrhosis (Child 5A) and with a previous normal renal function (estimated Glomerular Filtration . The patient was switched to entecavir at a dose of 1 mg/day, with both suppression of viremia and improvement of osteomalacia and Fanconi syndrome; the patient's follow-up is still ongoing after 22 months. Sviluppo di osteomalacia e di sindrome di Fanconi durante il trattamento con adefovir in un paziente affetto da cirrosi epatica HBV-correlataCMI 2014; 8(4): 109-114 http://dx.doi.org/10.7175/cmi.v8i4.969 1 Rete Regionale di informazione sul farmaco,