What are the special considerations of antiviral therapy in select patients with hepatitis B (HBV) (Hep B)?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Special attention must be given to patients on liver transplantation lists. Initiation of treatment with entecavir or tenofovir is of cardinal importance before and after liver transplantation in order to achieve viral suppression and to prevent recurrence of the disease after the procedure. Combination therapy with ETV and TDF or, more rarely, TDF with FTC or 3TC can be considered if drug-resistant mutants are present or for patients with failing first-line therapy.

Caution must also be used with long-term and high-dose administration of adefovir or tenofovir therapy in patients with chronic HBV disease. In a National Institutes of Health (NIH) study, 15% of patients on adefovir or tenofovir for 2-9 years developed proximal renal tubular dysfunction, defined as de novo incidence of 3 of the following 5 features [65] :

  • Hypophosphatemia

  • Hypouricemia

  • Elevated serum creatinine level

  • Proteinuria

  • Glycosuria

Switching to other antiviral agents in the study allowed for partial reversal of the renal tubular dysfunction. [65]

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