Successful treatment with adefovir dipivoxil in a patient with fibrosing cholestatic hepatitis and lamivudine resistant hepatitis B virus

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 dipivox il has recently been reported to be a potent and highly effective inhibitor of HBV replication in both wild-type and lamivudine resistant HBV infectio n. We report a case of FCH 15 months after liver transplantation for HBV re lated cirrhosis despite therapy with lamivudine and hepatitis B immunoglobu lin (HBIg). Within two weeks of commencing treatment with adefovir dipivoxi l 10 mg once daily, the patient had made a remarkable recovery with resolut ion of jaundice and normalisation of liver biochemistry. HBV DNA and hepati tis B e antigen were lost from serum subsequently and liver histology had i mproved at four months. This case report suggests firstly, that advanced FC H can be reversed and secondly, that addition of adefovir dipivoxil to lami vudine and HBIg may be an effective antiviral strategy.