Sustained virological and biochemical responses to lamivudine and adefovir dipivoxil combination in

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Case Report

Sustained virological and biochemical responses to lamivudine and adefovir

dipivoxil combination in a chronic hepatitis B infection despite mutations

conferring resistance to both drugs

Sylvie Larrat , Marie-Noelle Hilleret , Raphaele Germi , n Lupo , Sandrine

Nicod , Jean-Pierre Zarski , Jean-Marie Seigneurin and Patrice Morand

Comparative Hepatology 2008, 7:3doi:10.1186/1476-5926-7-3

Published: 12 March 2008

Abstract (provisional)

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.

Case presentation

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.

Conclusion

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.

The complete article is available as a provisional PDF. The fully formatted PDF

and HTML versions are in production.

http://www.comparative-hepatology.com/content/7/1/3

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