Reactivation of lamivudine-resistant occult hepatitis B in an HIV-infected patient undergoing cytotoxic chemotherapy.
BACKGROUND
Reactivation of occult hepatitis B virus (HBV) infection is a well-known complication of cytotoxic chemotherapy. Lamivudine prophylaxis is recommended to reduce the incidence and severity of hepatitis in this context.


METHODS
An HIV-infected patient positive for HBs antigen became positive for HBc antibody alone under lamivudine given as part of antiretroviral therapy. He was treated with chemotherapy for non-Hodgkin's lymphoma while under lamivudine. Then, he developed HBV-related hepatitis that led to delay chemotherapy. He received adefovir that induced a dramatic decline in HBV DNA load and a normalisation of hepatic enzyme levels. However, the patient died of a relapse of lymphoma. Retrospective analysis of stored plasma samples showed evidence of lamivudine-resistant occult hepatitis before the onset of chemotherapy and reactivation of the HBV mutant.


CONCLUSIONS
To our knowledge, this is the first report of occult hepatitis reactivation due to lamivudine-resistant mutant selected under lamivudine therapy in an HIV-infected patient. Our study underlines the need to carefully investigate lamivudine resistance in HIV-infected patients with occult infection under lamivudine therapy. Those patients should be monitored with the addition of anti-viral agents effective against the mutant strain.
Schnepf
Nathalie
N
AP-HP, Hôpital Lariboisière, Service de Bactériologie-Virologie, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
Sellier
Pierre
P
Bendenoun
Marc
M
Zini
Jean-Marc
JM
Sanson-le Pors
Marie-José
MJ
Mazeron
Marie-Christine
MC
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D006678:HIV / Q000187:drug effects / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D008297:Male; D014775:Virus Activation / Q000187:drug effects
D019259:Lamivudine