title: Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine.
abstract: Lamivudine is a nucleoside analog with activity against human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Patients coinfected with HIV and HBV may have hepatitis flares when lamivudine therapy is discontinued or when resistance of HBV to lamivudine emerges. This retrospective, descriptive study conducted in three tertiary care medical centers describes patients coinfected with HIV type 1 and HBV who presented with a spectrum of clinical and subclinical hepatitic responses to lamivudine withdrawal or resistance. One patient had fulminant hepatic failure and a second patient had subclinical hepatitis when lamivudine therapy was discontinued and a more efficacious antiretroviral regimen was substituted. Three patients had flares of hepatitis after 13 to 18 months of lamivudine therapy. Lamivudine withdrawal or emergence of lamivudine-resistant mutants in patients coinfected with HIV and HBV may result in severe hepatitis. Clinicians caring for patients with coinfection with HIV and HBV should be aware of the possibility that a hepatitis B flare may occur in previously asymptomatic carrier patients.
authors.affiliation: Department of Medicine, University of Colorado Health Sciences Center, Denver, USA. mary.bessesen@med.va.gov
authors.forename: M
authors.initials: M
authors.lastname: Bessesen
authors.forename: D
authors.initials: D
authors.lastname: Ives
authors.forename: L
authors.initials: L
authors.lastname: Condreay
authors.forename: S
authors.initials: S
authors.lastname: Lawrence
authors.forename: K E
authors.initials: KE
authors.lastname: Sherman
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D015497:HIV-1; D006513:Hepatitis B e Antigens; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents; D006513:Hepatitis B e Antigens; D019259:Lamivudine