title: Molecular analysis of hepatitis B virus (HBV) in an HIV co-infected patient with reactivation of occult HBV infection following discontinuation of lamivudine-including antiretroviral therapy.
abstract: BACKGROUND
  Occult hepatitis B virus (HBV) infection (OBI) is characterized by HBV DNA persistence even though the pattern of serological markers indicates an otherwise resolved HBV infection. Although OBI is usually clinically silent, immunocompromised patients may experience reactivation of the liver disease.
  
  
  METHODS
  We report the case of an individual with human immunodeficiency virus (HIV) infection and anti-HBV core antibody positivity, who experienced severe HBV reactivation after discontinuation of lamivudine-including antiretroviral therapy (ART). HBV sequencing analysis showed a hepatitis B surface antigen escape mutant whose presence in an earlier sample excluded reinfection. Molecular sequencing showed some differences between two isolates collected at a 9-year interval, indicating HBV evolution. Resumption of ART containing an emtricitabine/tenofovir combination allowed control of plasma HBV DNA, which fell to undetectable levels.
  
  
  CONCLUSIONS
  This case stresses the ability of HBV to evolve continuously, even during occult infection, and the effectiveness of ART in controlling OBI reactivation in HIV-infected individuals.
authors: Department of Biomedical Sciences and Public Health, Università Politecnica Marche, Ancona, Italy.
authors: Andrea
authors: A
authors: Costantini
authors: Katia
authors: K
authors: Marinelli
authors: Giulia
authors: G
authors: Biagioni
authors: Alessia
authors: A
authors: Monachetti
authors: Monica L
authors: ML
authors: Ferreri
authors: Luca
authors: L
authors: Butini
authors: Maria
authors: M
authors: Montroni
authors: Aldo
authors: A
authors: Manzin
authors: Patrizia
authors: P
authors: Bagnarelli
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000008:administration & dosage*; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D019143:Evolution, Molecular; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008875:Middle Aged; D008969:Molecular Sequence Data; D020125:Mutation, Missense; D017422:Sequence Analysis, DNA
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine