Successful rescue therapy with tenofovir in a patient with hepatic decompensation and adefovir resistant HBV mutant.
BACKGROUND
Prolonged adefovir therapy exposes to the emergence of adefovir resistant hepatitis B virus mutants. Initial reports of the rtN236T mutation showed preserved sensitivity to lamivudine; however, complex mutations are emerging with reduced susceptibility to lamivudine.


METHODS
After 2 years of therapy, a cirrhotic patient developed the rtN236T and rtA181T adefovir resistant mutations. He had been previously treated with lamivudine, developed lamivudine resistance and, despite good compliance, had an incomplete response to adefovir. Adefovir resistance resulted in viral breakthrough with hepatitis flare-up and liver decompensation. Tenofovir had an excellent antiviral effect allowing sustained control of viral replication and reversal of hepatic failure.


CONCLUSIONS
In patients with cirrhosis, adefovir resistance can lead to severe hepatitis. Tenofovir appears to be an effective treatment of adefovir resistant mutants. Incomplete control of viral replication with adefovir requires monitoring for viral resistance and should prompt a change in antiviral treatment.
Ratziu
Vlad
V
Service d'Hépatogastroenterologie, Hôpital Pitié Salpêtrière and Université Pierre et Marie Curie, Paris, France. vratziu@teaser.fr
Thibault
Vincent
V
Benhamou
Yves
Y
Poynard
Thierry
T