Sustained virological and biochemical responses to lamivudine and adefovir dipivoxil combination in a chronic hepatitis B infection despite mutations conferring resistance to both drugs.
BACKGROUND
Sequential monotherapies of nucleotide analogs used in chronic hepatitis B treatment can lead to the selection of a resistance mutation to each antiviral drug.


METHODS
A patient with chronic hepatitis B was successively treated with lamivudine monotherapy, lamivudine-adefovir dual therapy, adefovir monotherapy and again with an adefovir-lamivudine dual therapy. Lamivudine-associated mutations (rtL180M and rtM204V/I) followed by adefovir-associated mutations (rtN236T and rtA181V) emerged during the two monotherapy regimens. Despite the presence of rtM204V/I, rtA181V, and rtN236T mutations at the beginning of the second dual therapy, sustained biochemical and virological responses have been observed thus far after 23 months.


CONCLUSIONS
This case illustrates that rtM204V/I, rtA181V, and rtN236T resistance mutations can coexist in a patient but do not preclude the recycling of lamivudine and adefovir in combination therapy, when no other therapeutic choices are available.
Larrat
Sylvie
S
Laboratoire de Virologie moléculaire et structurale, CHU de Grenoble BP 217, 38043 Grenoble cedex 09, France. slarrat@chu-grenoble.fr
Hilleret
Marie-Noëlle
MN
Germi
Raphaele
R
Lupo
Julien
J
Nicod
Sandrine
S
Zarski
Jean-Pierre
JP
Seigneurin
Jean-Marie
JM
Morand
Patrice
P