Early emergence of entecavir-resistant hepatitis B virus in a patient with hepatitis B virus/human immunodeficiency virus coinfection.
The efficacy of entecavir for patients with hepatitis B virus/human immunodeficiency virus coinfection has not been fully elucidated. Here we examined a patient coinfected with both viruses in whom entecavir-resistant hepatitis B virus appeared. The 60-year-old Japanese male with the coinfection received antiretroviral therapy including lamivudine. The therapy initially suppressed replication of both viruses, followed by reactivation of the hepatitis B virus alone by 2 years of therapy. He subsequently received entecavir therapy in addition to the antiretroviral regimen. After entecavir administration, the hepatitis B virus DNA level was slightly reduced, but then increased after 6 months of entecavir therapy. In the sequencing analysis of hepatitis B virus, no drug resistance-associated amino acid substitutions were observed in the reverse transcriptase (rt) domain before antiretroviral therapy. The lamivudine-resistant amino acid substitutions at rt173, rt180 and rt204 were detected before entecavir administration, and further the entecavir-resistant rt202 substitution was observed after 6 months of entecavir therapy. The full-length hepatitis B sequences showed that the viral strain derived from the patient belonged to genotype H. In summary, this report describes a patient with hepatitis B virus/human immunodeficiency virus coinfection who received entecavir therapy in addition to an antiretroviral regimen and showed the early emergence of entecavir-resistance hepatitis B virus. In entecavir therapy for patients infected with both viruses, great care should be taken with respect to the emergence of entecavir-resistant hepatitis B virus, especially in patients with pre-existing lamivudine-resistant virus.
Kanada
Aimi
A
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
Takehara
Tetsuo
T
Ohkawa
Kazuyoshi
K
Kato
Michio
M
Tatsumi
Tomohide
T
Miyagi
Takuya
T
Sakamori
Ryotaro
R
Yamaguchi
Shinjiro
S
Uemura
Akio
A
Kohga
Keisuke
K
Sasakawa
Akira
A
Hikita
Hayato
H
Kawamura
Kiyomi
K
Kanto
Tatsuya
T
Hiramatsu
Naoki
N
Hayashi
Norio
N