Entecavir resistance in a patient with treatment‑naïve HBV: A case report

Abstract

Among nucleos(t)ide analogue therapies for hepatitis B virus (HBV) treatment, entecavir (ETV) and tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide are associated with the lowest rate of drug resistance. ETV is a drug requiring at least three substitutions in the reverse transcriptase (RT) domain to develop resistance, which is a rare occasion in treatment-naïve patients. However, pre-existing or acquired single mutations in the RT domain could lead to a virological breakthrough, after viral suppression. The present case report describes a 58-year-old female patient with hepatitis B virus (HBV) and high viral load who started HBV treatment with ETV. After 85 weeks of treatment, HBV-DNA declined to 0 IU/ml and remained undetectable for 3 years. However, after that period of time, the HBV-DNA rebounded, followed by the rise of liver enzymes (aspartate aminotransferase and alanine transaminase). Only the substitution M204I was detected in the HBV polymerase region. The patient was then switched to TDF treatment, achieving normalization of the liver enzymes and a decline in HBV-DNA levels. The present case report suggests that nucleoside-naïve patients should be cautiously monitored for resistance, even more than biochemically (transaminases, bilirubin) and virologically (HBV-DNA), even if complete HBV suppression is achieved.

Corynebacterium striatum Bacteremia during SARS-CoV2 Infection: Case Report, Literature Review, and Clinical Considerations

“…Overall, although the patient that we presented had no relevant immunosuppression diseases [ 33 , 49 , 50 , 51 ], except for cancer diagnosis, she presumably died due to disseminated intravascular coagulation (CID)-like syndrome caused by septic shock. Despite the SARS-CoV2 infection, the patients did not have any lung involvement; however, we could not definitely rule out viral effects such as hyperinflammation and hypercoagulopathy [ 52 , 53 , 54 ].…”

Pain crisis management in a patient with sickle cell disease during SARS‑CoV‑2 infection: A case report and literature review

“…As suggested by guidelines and literature evidence (19,20), an analgesic cocktail was administered, along with RBC exchange to achieve prompt pain control. Moreover, due to the presence of fever along with increased CRP and procalcitonin levels, antibiotic therapy was administered, and cultural tests were performed to rule out and treat bacterial superinfections, whereas viral coinfections, including HIV, HBV and HCV, were already excluded according to protocols (21)(22)(23)(24)(25)(26)(27). Previous research has highlighted the risk of delaying appropriate management during VOCs in patients with SCD (12).…”

HIV Infection Diagnosis in a Late Presenter Patient during a Severe Imported Falciparum Malaria: A Challenging

“…Malaria and HIV coinfection led to a deeper immunosuppressive condition which often poorly affect the outcome of both the diseases [20], [21], also compromising treatment success of other occurring infections [22], [23]. Moreover, it is also fundamental to screen these patients for other infections, such as HBV [24] and HCV [20], sharing both the ways of transmission and epidemiological characteristics.…”