Lu JC, Liu LG, Lin L, Zheng SQ, Xue Y. Incident hepatocellular carcinoma developing during tenofovir alafenamide treatment as a rescue therapy for multi-drug resistant hepatitis B virus infection: A case report and review of the literature. World J Clin Cases 2018; 6(13): 671-674 [PMID: 30430123 DOI: 10.12998/wjcc.v6.i13.671]
Corresponding Author of This Article
Yuan Xue, PhD, Chief Doctor, Department of Liver Diseases, the Third People’s Hospital of Changzhou, No. 300, Lanling North Road, Changzhou 213000, Jiangsu Province, China. xueyuan80908@163.com
Research Domain of This Article
Pharmacology & Pharmacy
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2018; 6(13): 671-674 Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.671
Incident hepatocellular carcinoma developing during tenofovir alafenamide treatment as a rescue therapy for multi-drug resistant hepatitis B virus infection: A case report and review of the literature
Jian-Chun Lu, Long-Gen Liu, Lin Lin, Shu-Qin Zheng, Yuan Xue
Jian-Chun Lu, Long-Gen Liu, Shu-Qin Zheng, Yuan Xue, Department of Liver Diseases, the Third People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
Jian-Chun Lu, Long-Gen Liu, Lin Lin, Shu-Qin Zheng, Yuan Xue, Institute of Hepatology, the Third People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
Lin Lin, Department of Pharmacy, the Third People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
Author contributions: Xue Y designed the research; Lu JC, Liu LG, Lin L and Zheng SQ collected and confirmed the data; Lu JC wrote the manuscript; Xue Y revised the manuscript.
Supported by the Chinese Foundation for Hepatitis Prevention and Control- WBE Liver Fibrosis Foundation, No. WBE20161013; and the Science and Technology project of Changzhou, No. CJ20160024 and No. CJ20179030.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuan Xue, PhD, Chief Doctor, Department of Liver Diseases, the Third People’s Hospital of Changzhou, No. 300, Lanling North Road, Changzhou 213000, Jiangsu Province, China. xueyuan80908@163.com
Telephone: +86-519-82008326 Fax: +86-519-82009010
Received: July 24, 2018 Peer-review started: July 24, 2018 First decision: August 30, 2018 Revised: September 5, 2018 Accepted: October 12, 2018 Article in press: October 12, 2018 Published online: November 6, 2018 Processing time: 105 Days and 22.3 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 60-year-old individual suffered liver cirrhosis and renal dysfunction, and was infected with multidrug-resistant hepatitis B virus (HBV) before tenofovir alafenamide (TAF) treatment.
Clinical diagnosis
He was diagnosed with HBeAg negative compensated liver cirrhosis at admission.
Differential diagnosis
The differential diagnosis included alcoholic cirrhosis and hepatocellular carcinoma.
Laboratory diagnosis
Laboratory tests showed that HBV DNA peaked to 2.47 log10IU/mL and the estimated glomerular filtration rate declined to < 50 mL/min/1.73 m2 before TAF treatment.
Imaging diagnosis
Ultrasonic tests showed liver cirrhosis and splenomegaly at admission.
Pathological diagnosis
Hepatocellular carcinoma was diagnosed according to liver pathology during follow-up.
Treatment
Given the renal insufficiency and lack of full viral suppression under tenofovir disoproxil fumarate, TAF was started at 25 mg per day.
Related reports
Grossi et al[7] reported the use of TAF as a rescue therapy in a cirrhotic patient with a history of Fanconi syndrome and multi-drug resistance, while in our case, the patient received TAF treatment and hepatocellular carcinoma (HCC) occurred during follow-up.
Term explanation
The pathogenesis of HCC is thought to be multifactorial, and liver cirrhosis is an important risk factor for HCC. Even though a potent NA can maintain HBV suppression, it reduces but does not eliminate the risk of HCC development.
Experiences and lessons
The surveillance for HCC should be continued during TAF treatment.
