title: Identification of more than one mutation in the hepatitis B virus polymerase gene arising during prolonged lamivudine treatment.
abstract: Lamivudine has been shown to be a potent and nontoxic inhibitor of hepatitis B virus (HBV) replication in chronically infected patients. During prolonged treatment, drug resistance may develop, related to a mutation of Met to Val or Ile in the YM552DD motif of the HBV DNA polymerase gene. Analysis of the HBV DNA polymerase gene from 8 chronic hepatitis B patients with suspected resistance to lamivudine showed that in addition to a mutation in the YM552DD motif, a second mutation located in the B domain of this gene, a Leu528-to-Met528 change, was consistently and exclusively found in 4 patients showing the YV552DD motif. This suggests a functional or structural relationship between these domains. Since the presence of both the YI552DD and YV552DD motif sometimes preceded the exclusive presence of the YV552DD motif, we conclude that the YI552DD motif could occur as a temporal intermediate. After cessation of therapy, the wild type sequences reemerged.
authors.affiliation: Department of Gastroenterology, University Hospital Rotterdam, The Netherlands. niesters@viro.fgg.eur.nl
authors.forename: H G
authors.initials: HG
authors.lastname: Niesters
authors.forename: P
authors.initials: P
authors.lastname: Honkoop
authors.forename: E B
authors.initials: EB
authors.lastname: Haagsma
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
authors.forename: S W
authors.initials: SW
authors.lastname: Schalm
authors.forename: A D
authors.initials: AD
authors.lastname: Osterhaus
mesh_terms: D019943:Amino Acid Substitution; D017931:DNA Primers; D004279:DNA, Viral / Q000097:blood*; D004259:DNA-Directed DNA Polymerase / Q000096:biosynthesis / Q000235:genetics*; D006509:Hepatitis B / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000187:drug effects / Q000201:enzymology / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
chemical_list: D017931:DNA Primers; D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D004259:DNA-Directed DNA Polymerase