Viral evolutionary changes during tenofovir treatment in a chronic hepatitis B patient with sequential nucleos(t)ide therapy.
A 54-year-old man diagnosed with HBeAg-positive chronic hepatitis B (CHB) was treated with entecavir (ETV) 1mg/day following an initial unsuccessful lamivudine (LAM) treatment (rtL180M, rtM204V/I). Subsequently, virological breakthrough with ETV mutation (rtT184A/L) developed. The LAM and adefovir combination therapy was followed by virological breakthrough. The therapy had been switched to TDF monotherapy. However, this patient experienced virological breakthrough under TDF with a HBV strain bearing rtL80M, rtL180M, rtM204V/I, rtA200V, rtF221Y, rtS223A, rtT184A/L, rtR153Q, and rtV191I combined mutations without rtA194T mutation. TDF resistance may emerge due to multi-site polymerase mutations rather than single-site polymerase mutation.
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Hyun Woong
HW
Lee
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Hye Young
HY
Chang
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Suh Yoon
SY
Yang
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea. Electronic address: mdjoon@cau.ac.kr.
Hyung Joon
HJ
Kim
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D057915:Drug Substitution; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D063065:Organophosphonates / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000225:Adenine
Chronic hepatitis B; Mutation; Resistance; Tenofovir