In therapy of chronic hepatitis B, there are new and exciting developments in antivirals such as nucleotide analogues. Adefovir dipivoxil is an oral prodrug of adefovir, a nucleotide analogue of adenosine monophosphate. This agent has a potent in vitro and in vivo effect against herpes virus, retroviruses, and hepadnaviruses. In the hepatitis B virus (HBV) setting, adefovir dipivoxil inhibits both the wild type and lamivudine-resistant HBV strains. The safety profile of adefovir dipivoxil 10 mg is excellent, but higher doses can produce renal tubular damage, particularly when the drug is used for prolonged therapy. Adefovir dipivoxil is an important new addition to the current first-line treatments for HBeAg positive and negative chronic hepatitis B, as well as being rescue therapy for lamivudine-resistant HBV strains. It is also licensed for use in adults with decompensated liver disease, as well as compensated liver disease where there is evidence of active viral replication, persistently elevated serum alanine aminotransferase levels and active liver inflammation and fibrosis. However, a longer follow-up is needed to establish the long term safety and efficacy of adefovir dipivoxil in patients with chronic HBV infection.
Adenine/adverse effects/*analogs & derivatives/*therapeutic use ; Antiviral Agents/adverse effects/*therapeutic use ; Hepatitis B, Chronic/*drug therapy ; Humans ; Liver Diseases/drug therapy ; *Phosphonic Acids

Primary hepatic neuroendocrine cell carcinoma is a very rare tumor. We experienced a 75-year-old woman with primary hepatic neuroendocrine carcinoma presenting with pyogenic liver abscess. Abdominal CT scan revealed a multiseptated liver abscess and an enlarged lymph node in portocaval portion. We performed percutaneous drainage of the liver abscess, but the amount of drained pus did not decrease after 20 days. The follow-up abdominal CT scan showed that the cystic portion of liver abscess had been replaced by the solid tumor. Microscopic examination of the tumor tissue showed nests of epithelial cells with uniform round hyperchromatic nuclei and high nuclear to cytoplasmic ratio. Immunohistochemical staining was strongly positive for synaptophysin and chromogranin A.
Adenine/analogs & derivatives/therapeutic use ; Antiviral Agents/*adverse effects/therapeutic use ; Drug Eruptions/diagnosis/*pathology ; Female ; Hepatitis B, Chronic/*drug therapy ; Humans ; Ichthyosis/chemically induced/pathology ; Lamivudine/*adverse effects/therapeutic use ; Middle Aged ; Phosphonic Acids/therapeutic use

Adefovir dipivoxil, an acyclic nucleoside analogue, has been approved for the treatment of patients with chronic hepatitis B. This agent is efficacious particularly in those who have developed lamivudine resistance. The report according to hypophosphatemia induced by low dose adefovir therapy is very rare. We report one case in which osteomalacia with hypophosphatemia developed in a patient with chronic hepatitis B on adefovir dipivoxil at a low dose, 10 mg daily. A 66-year-old man, who had been taking adefovir for more than 4 years due to lamivudine resistance, presented with muscle weakness and bone pain in both thighs. After 3 years of adefovir therapy, hypophosphatemia and elevated serum alkaline phosphatase levels had been noted. A bone scan showed multiple hot uptakes. All the image findings and clinical symptoms, such as bone pain and muscle weakness were improved after correcting the hypophosphatemia with oral phosphorous supplementation.
Adenine/adverse effects/*analogs & derivatives/therapeutic use ; Aged ; Alkaline Phosphatase/blood ; Antiviral Agents/*adverse effects/therapeutic use ; DNA, Viral/blood ; Dietary Supplements ; Hepatitis B, Chronic/*drug therapy ; Humans ; Hypophosphatemia/*chemically induced/complications ; Liver Cirrhosis/diagnosis ; Male ; Osteomalacia/*diagnosis/etiology ; Phosphates/blood ; Phosphonic Acids/*adverse effects/therapeutic use ; Whole Body Imaging

Adefovir dipivoxyl (ADV) effectively suppresses hepatitis B virus (HBV) replication but exhibits nephrotoxicity with severe hypophosphatemia when administered at a high dosage. This is the first report of severe hypophosphatemic osteomalacia induced by ADV at 10 mg/day. A 42-year-old man with HBV-related chronic liver disease presented with generalized bone pain, especially in the left ankle. He had been taking ADV for more than 1.5 years following a clinical breakthrough due to lamivudine-resistant HBV. Aggravating severe hypophosphatemia and elevated serum alkaline phosphatase levels with high bone fraction had been noted after 6 months of ADV therapy. Bone densitometry, simple bone X-rays, and a whole-body bone scan demonstrated osteoporosis and multiple areas with hot uptake, especially in the left ankle. All the image findings and symptoms improved after correcting the hypophosphatemia.
Absorptiometry, Photon ; Adenine/administration & dosage/adverse effects/*analogs & derivatives ; Adult ; Antiviral Agents/administration & dosage/*adverse effects ; Bone Density ; DNA, Viral/analysis ; Drug Resistance, Viral ; Hepatitis B virus/drug effects ; Hepatitis B, Chronic/complications/*drug therapy/virology ; Humans ; Hypophosphatemia/*chemically induced ; Lamivudine/therapeutic use ; Liver Cirrhosis/*virology ; Male ; Phosphonic Acids/administration & dosage/*adverse effects ; Tomography, X-Ray Computed