Grand Rounds

Tenofovir and Hepatitis B - How to manage?

1Seth G S Medical College, Mumbai, India, 2Pediatric Gastroenterology and Hepatology, Levioza Health Care, Mumbai, India

Address for Correspondence: Yash Sonagra, 1103/4 Callalily Y wing, Nahar, Powai, Andheri East, Mumbai-400072.

Keywords: Tenofovir, Hepatitis B, Tenofovir monitoring

Clinical Problem :
Case- A 16 years old girl was referred to us for positive serum HbsAg test. She has acute lymphoblastic leukemia diagnosed at age of nine years for which she received multiple blood transfusions. Her chemotherapy lasted for two and a half years. At age of 15 years she was detected to be HbsAg positive on screening. Her HIV ELISA and hepatitis C antibody test were negative. Her hepatitis E antibody was also positive and hepatitis B (HBV) viral load was >105 copies/ml. She underwent a liver biopsy which showed ground glass appearance of hepatocytes without fibrosis or inflammation. She received 15 doses of interferon Alpha along with Lamivudine for 1 year. She was subsequently referred for further management. On physical examination, her, weight was 51 kgs (10th percentile), There was no icterus and no hepatosplenomegaly. Her liver function test showed bilirubin 0.6 mg/dl, SGOT- 84 IU/L, SGPT-118 IU/L, total proteins of 7.6 gm/dl, Albumin of 4 gm/dl, prothrombin time of 10 sec (control= 25 sec), partial thromboplastin time of 21.3 sec (control= 25). Ultrasound abdomen and doppler of portal system was normal. Her HBeAg antigen was positive (1194.9 units) and HBV viral load was 10,80,00,000 copies/ml. She was started on Adefovir. However, she continued to remain e antigen positive and HBV viral load was still elevated (1,092,078 copies/ml) at end of 2 years of treatment though her LFT had normalized. Her mutation analysis showed sensitivity to Lamivudine. She was continued on Adefovir and Lamivudine was reintroduced. However, even after 2 years, her HBV viral load was 40,97,589 copies/ml and e antigen was still positive. Thus, her therapy was stopped and she was advised follow up. In the next 3 months, her liver enzymes started rising again. She was later started on Tenofovir Disoproxil Fumarate.

How should this child be monitored on Tenofovir Disoproxil Fumarate?
How should this child be monitored on Tenofovir Disoproxil Fumarate?
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