Hélène Fontaine, MD; Valérie Thiers, PhD; Stanislas Pol, MD, PhD
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Fontaine H., Thiers V., Pol S.; Hepatitis B Virus Genotypic Resistance to Lamivudine. Ann Intern Med. 1999;131:716-717. doi: 10.7326/0003-4819-131-9-199911020-00027
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Published: Ann Intern Med. 1999;131(9):716-717.
TO THE EDITOR:
Lamivudine is a potent inhibitor of HIV reverse transcriptase and of hepatitis B virus (HBV) DNA polymerase (1). Its long-term efficacy in chronic HBV infection is limited by relapse after discontinuation and breakthrough during therapy by genotypic resistance. Hepatitis B virus breakthrough has been described in immunocompetent patients and patients who have received liver transplants. We report the first cases of HBV lamivudine resistance in HIV-infected patients.
Nineteen patients with HIV and HBV were treated with lamivudine (300 mg/d) for a median of 16 months (range, 4 to 34 months). All patients were negative for hepatitis C and delta virus markers. All patients were men (median age, 37 years [range, 32 to 52 years]) who underwent liver biopsy before treatment; 53% were cirrhotic, and the median Knodell score was 11 (range, 2 to 18). At the beginning of treatment, all patients were HBV DNA positive by liquid-phase hybridization (Murex Diagnostic, Chatenay-Malabry, France), with a median viremia level of 3736 pg/mL (range, 6 to 85 000 pg/mL). All 19 patients became HBV DNA negative after initiation of lamivudine therapy, and 7 developed a breakthrough—as defined by reappearance of detectable serum HBV DNA—after 8, 10, 11, 19, 23, 28, and 34 months of therapy. The rate of breakthrough increased with the duration of treatment, and most breakthroughs (6 of 7) occurred after 10 months; the percentage of breakthrough occurrence was 36.84% after a median treatment duration of 16 months. No histologic or virologic differences were seen between the 7 patients with breakthrough and the 12 patients without breakthrough. However, duration of treatment was significantly longer in patients with breakthrough than in those without breakthrough (23 months compared with 12 months; P < 0.05). In 1 patient, breakthrough occurred despite hepatitis B e antigen (HBeAg)/anti-HBeAg seroconversion; anti-HBeAg antibodies disappeared, and the patient became positive for HBeAg after breakthrough.
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