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Adefovir Dipivoxyl for the Treatment of Delta-Related Liver Cirrhosis

Clinical Specialist, Research Assistant, Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari, Bari, Italy

Vincenzo O Palmieri, MD

Associate Professor of Internal Medicine, Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari

Piero Portincasa, MD PhD

Associate Professor of Internal Medicine, Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari

Giuseppe Palasciano, MD

Professor of Internal Medicine, Director, Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari

Reprints: Dr. Grattagliano, Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari, 70124 Bari, Italy, fax 39-080-5478232, i.grattagliano{at}semeiotica.uniba.it

OBJECTIVE: To report a case suggesting the beneficial effect of adefovir dipivoxyl in patients with delta-related decompensated liver cirrhosis ineffectively treated with lamivudine.

CASE SUMMARY: A 55-year-old woman with chronic hepatitis B virus (HBV), antihepatitis Be positive, and hepatitis delta virus (HDV)-related decompensated liver cirrhosis (Child-Pugh score B9) was awaiting liver transplantation. During this time, she was treated with lamivudine 100 mg/day; however, the drug was stopped after 8 months because it did not produce viral clearance or return serum aminotransferase levels to within normal limits. The patient was not a candidate for interferon alfa therapy but was prescribed adefovir dipivoxyl 10 mg/day. Five months later, serum aminotransferase levels had normalized and, after 7 months of treatment with adefovir, the patient became negative for serum HBV-DNA and immunoglobulin M (IgM) antidelta. At the time of writing (20 mo of therapy), the HBV-DNA and IgM antidelta remained negative, whereas hepatitis B surface antigen and circulating HDV-RNA were positive. No adverse effects associated with adefovir were reported, and the Child-Pugh score (A6) had improved.

DISCUSSION: This is the first reported case of some beneficial biochemical and serologic effects of adefovir dipivoxyl in the treatment of delta cirrhosis. The virologic pattern of the patient after adefovir is indicative of poor liver disease activity and prospectively enhances liver transplantation outcome, indicating that adefovir might also be useful in the phase prior to liver transplantation.

CONCLUSIONS: Although we have no plausible explanation for our patient's favorable response to adefovir treatment, this case contributes to the knowledge regarding treatment of this very difficult condition as well as adefovir efficacy. Given the positive outcome, this report suggests that adefovir might be beneficial in patients with delta-related liver cirrhosis not responsive to previous lamivudine therapy. Based on the high tolerability of this therapy, this case encourages clinical trials.

Key Words: adefovir dipivoxyl, delta virus, HDV-RNA, liver transplantation

Published Online, August 1, 2006. www.theannals.com, DOI 10.1345/aph.1H104