Low-dose adefovir dipivoxil–induced hypophosphatemia osteomalacia in five chronic hepatitis B virus–infected patients. Is low-dose adefovir dipivoxil–induced nephrotoxicity completely reversible?

Abstract

Adefovir dipivoxil (ADV) is one of the most important nucleostide analogues currently in use for the treatment of chronic hepatitis B virus (HBV) infection. Low-dose ADV-induced nephrotoxicity in most cases was reported to be reversible after the discontinuation of ADV or by decreasing the dose of ADV. In our study, we have 5 documented cases of low-dose ADV-induced hypophosphatemia osteomalacia with or without Fanconi syndrome which were diagnosed in our hospital between 2010 and 2017. Three patients were observed to have a full recovery after the discontinuation of ADV. Two patients had persistently elevated urine β₂-microglobulin levels and out of these two patients, one patient had persistent hypophosphatemia after the cessation of ADV. These cases illustrated that the use of low-dose ADV increased the risk of nephrotoxicity, and in some patients, low-dose ADV-induced nephrotoxicity was not completely reversible. Patients of East Asian origin, especially those with a low body mass index, were prone to a relatively higher risk of developing low-dose ADV-induced nephrotoxicity; therefore, it was worth paying attention to the side effects caused by low-dose ADV.

Keywords:

• hypophosphatemia osteomalacia
• chronic hepatitis B virus
• adefovir dipivoxil

Acknowledgments

We thank the patients for their cooperation.

Ethical approval and copyright

The study was approved by the institutional ethical committee of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University. All patients in this case series provided written informed consent for the case details to be published.

Disclosure

The authors report no conflicts of interest in this work.