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Canadian Journal of Gastroenterology
Volume 14, Issue 8, Pages 725-727
http://dx.doi.org/10.1155/2000/142782
Brief Communication

Fatal Hepatic Decompensation in a Patient with Hepatitis B Cirrhosis Following Famciclovir Withdrawal

Robert P Myers,1 Rabindra Chaudhary,1 Kevin Fonseca,1 and Samuel S Lee1

1Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
2Diagnostic Virology Division, Laboratory Centre for Disease Control, Winnipeg, Manitoba, Canada
3Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada

Received 4 July 2000; Revised 4 July 2000

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatitis B virus (HBV) infection is a major cause of chronic liver disease worldwide. Famciclovir is a nucleoside analogue with potent antiviral activity that appears promising in the management of patients with HBV infection. No data exist regarding the safety of nucleoside analogue withdrawal in patients treated for HBV cirrhosis. The authors describe a 41-year-old man with compensated HBV cirrhosis who developed fatal hepatic decompensation due to a rebound in viral replication within six weeks of discontinuing famciclovir therapy. Although several mutations in the HBV DNA polymerase gene have been documented, none has been associated with famciclovir resistance or adverse clinical outcomes. Clinicians should consider the risk of inducing serious flares in hepatic inflammation as a result of abrupt nucleoside analogue withdrawal. Until further data are available regarding the safety of withdrawal of these agents, indefinite treatment may be required in patients with established cirrhosis.