A major side effect of ribavirin (RBV) is a hemolytic anemia. One of the causes of hemolytic anemia is considered to be oxidative stress to erythrocytes. Recently, a beneficial effect of eicosapentaenoic acid (EPA) for ribavirin-induced anemia has been reported. This study evaluated effects of EPA for ribavirin-induced anemia and thioredoxin (TRX) as an indicator of oxidative stress in chronic hepatitis C patients within 8 weeks. Nighteen of 41 patients who had received interferon/ribavirin therapy were treated with EPA (1800 mg/day) (EPA group). EPA therapy significantly prevented progression of anemia (P<0.01). Moreover, serum TRX levels were significantly decreased in EPA group at 4 weeks (P<0.01). Reduction of oxidative stress by EPA might play an important role for preventing ribavirin-induced anemia.
We report a case of both lamivudine (LAM) and adefovir dipivoxil (ADV) resistant liver cirrhosis type B. A 47-year-old woman was hospitalized with chronic active hepatitis with cirrhosis type B. Because her serum alanine aminotransferase (ALT) and hepatitis B virus (HBV) DNA level elevated, she was treated with LAM (100 mg/day). Serum ALT and HBV DNA reductions were observed in 4 months. Nine months after the administration of LAM, HBV DNA and ALT levels re-elevated following the appearance of YMDD mutant (YVDD+YIDD). Additional treatment with ADV (10 mg/day) was commenced, and her serum ALT was decreased during 3 months. However, breakthrough phenomena were observed again 26 months after ADV treatment. This is the first reported case of breakthrough hepatitis associated with both LAM-and ADV-resistant HBV.