studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1211A
2056
Long-term Renal Safety of Adefovir Dipivoxil Treatment
: Focused on development of Fanconi Syndrome
Sung Won Cho, Soo Yeon Cho, Choong Kyun Noh, Soon Sun
Kim, Dukyong Yoon, Rae Woong Park, In-Whee Park; Ajou University
School of Medicine, Suwon, Korea (the Republic of)
Background Adefovir dipivoxil (ADV) is a commonly used
antiviral agent for the treatment of hepatitis B virus or human
immunodeficiency virus infection. ADV exhibits dose-dependent
nephrotoxicity that can cause Fanconi syndrome. Fanconi
syndrome is a generalized dysfunction of the proximal renal
tubule resulting in impaired reabsorption and increased urinary
loss of phosphate and other solutes such as uric acid, glucose,
amino acids and bicarbonate. Although low-dose ADV therapy
(10mg/day) has been reported to be safe, there are increasing
number of reports stating that the long-term use of lowdose
ADV causes Fanconi syndrome. Therefore, we assessed
the incidence and clinical characteristics of Fanconi syndrome
during long-term ADV therapy of hepatitis B virus or human
immunodeficiency virus infection. Methods We constructed a
retrospective cohort composed of a total of 619 patients who
took ADV for more than 30 days in a single tertiary teaching
hospital between Jun 1994 and Dec 2013. Diagnosis of Fanconi
syndrome required de novo appearance of at least two
of three features: hypophosphatemia (below 2.5 mg/dL or
decrement at least 0.5 mg/dL from baseline), hypouricemia
(below 3.7 mg/dL or decline at least 0.5 mg/dL from baseline),
or serum creatinine elevation (above 1.2 mg/dL or by at
least 0.5 mg/dL from baseline). Results During the mean 27.6
± 21.6 months ADV-treated period, 44 patients (7.1%) exhibited
hypophosphatemia. Fourty-eight patients (7.8%) showed
hypouricemia and 17 patients (2.7%) presented serum creatinine
elevation. Among these patients, 6 patients (0.96%)
developed Fanconi syndrome. Median time to development
of Fanconi syndrome was 17.5 (range 15.17–35.07) months.
All patients were treated with ADV for chronic hepatitis B.
Conclusion Although Fanconi syndrome developed very rarely
during low dose of ADV treatment, it occurred certainly in some
patients. Physicians should carefully monitor the renal function
and the level of serum phosphate and uric acid during the ADV
treatment in particular after 1 year.
Disclosures:
The following authors have nothing to disclose: Sung Won Cho, Soo Yeon Cho,
Choong Kyun Noh, Soon Sun Kim, Dukyong Yoon, Rae Woong Park, In-Whee
Park
2057
The relationship between patient’s adherence to antiviral
therapy and virological response in chronic hepatitis
B and hepatitis C: Results of a 48-week observational
study
Iftihar Koksal, Seval Sonmez; Infectious Diseases, Black Sea Technical
University Faculty of Medicine, Trabzon, Turkey
Background:Patient’s adherence to antiviral drugs affects
the success of chronic hepatitis B(CHB) and hepatitisC(CHC)
treatment.In HBV, ‘non-adherence’ primarily refers to patientmissed
doses.In HCV, in contrast,‘non-adherence’ primarily
refers to dose reductions made by the clinician and early
treatment discontinuation due to side-effects. Aim: To investigate
the relationship between antiviral medication adherence
and virological response in CHB & CHC patients. Materials–
methods: Ninety-seven treated CHB (entecavir or tenofovir)
and CHC (peg-IFN+ribavirin) patients were followed up for
48 weeks in this prospective,non-interventional observational
study.Patients were evaluated for virological response at the
beginning of treatment and at the 4 th (CHC patients only),
12 th , 24 th and 48 th weeks.Adherence was evaluated by counting
prescribed drugs at each follow-up and through patient
adherence questionnaires. Results: Twenty-one patients were
excluded from the study.Of the 76 evaluated patients, 60.5%
(n=46) had CHB and 39.5% (n=30) had CHC; 42.1% of the
patients were women and 57.9% were men.Mean age was
45.18±13.2.Based on data obtained from drug counts, 83.9%
of the patients had at least one delay in drug administration at
each visit.The most common causes of delayed drug administrations
were omission (72.8%),running out of drugs and efforts
to avoid side-effects.In addition, 92.6% of chronic hepatitis
patients (n=68) exhibited adherence,and 92.1% of adherent
and 62.5% of non-adherent patients responded to treatment.
Adherent and non-adherent patient treatment response levels
were statistically significant (p