Sustained virological and biochemical responses to lamivudine and adefovir dipivoxil combination in a chronic hepatitis B infection despite mutations conferring resistance to both drugs.

Abstract

BACKGROUND:

Sequential monotherapies of nucleotide analogs used in chronic hepatitis B treatment can lead to the selection of a resistance mutation to each antiviral drug.

CASE PRESENTATION:

A patient with chronic hepatitis B was successively treated with lamivudine monotherapy, lamivudine-adefovir dual therapy, adefovir monotherapy and again with an adefovir-lamivudine dual therapy. Lamivudine-associated mutations (rtL180M and rtM204V/I) followed by adefovir-associated mutations (rtN236T and rtA181V) emerged during the two monotherapy regimens. Despite the presence of rtM204V/I, rtA181V, and rtN236T mutations at the beginning of the second dual therapy, sustained biochemical and virological responses have been observed thus far after 23 months.

CONCLUSION:

This case illustrates that rtM204V/I, rtA181V, and rtN236T resistance mutations can coexist in a patient but do not preclude the recycling of lamivudine and adefovir in combination therapy, when no other therapeutic choices are available.

• Authors: Sylvie Larrat, Marie-Noëlle Hilleret, Raphaele Germi, Julien Lupo, Sandrine Nicod, Jean-Pierre Zarski, Jean-Marie Seigneurin, Patrice Morand
• Journal: Comparative hepatology (Comp Hepatol) Vol. 7 Pg. 3 (Mar 12 2008) ISSN: 1476-5926 [Electronic] England
• PMID: 18336716 (Publication Type: Journal Article)