Long-term incidence of hepatitis B virus resistance to lamivudine in human immunodeficiency virus-infected patients

Abstract

Hepatitis B virus (HBV) resistance to lamivudine has not been extensively documented in human immunodeficiency virus (HIV)-infected patients. We studied the long-term incidence of HBV resistance to lamivudine in HIV-positive patients. Sixty-six HIV-HBV-coinfected patients were studied while receiving lamivudine (150 mg twice daily) as a part of antiretroviral therapy. All these patients had a detectable serum HBV DNA at the beginning of lamivudine therapy. Serum HBV DNA was quantified by molecular hybridization. Sequence analysis of the HBV polymerase was performed in patients who became resistant to lamivudine. After 2 months of lamivudine, HBV DNA became undetectable in 57 patients (86.4%, 95% CI: 75.7%-93.6%). After 2 years of lamivudine, 47% ؎ 18.6% of the patients, had sustained HBV-DNA suppression. In deeply immunosupressed HIV-HBV-coinfected patients, histological and biological activities are lower than in HIVnegative patients. 2,5 However, the natural history of liver fibrosis of coinfected patients has not been studied. Furthermore, the underlying liver disease of HIV-HBV-coinfected patients with immune restoration related to potent antiretroviral therapy is currently unknown.In HIV-HBV-coinfected patients, inhibition of HBV replication had been obtained in less than 8% of the cases with interferon alfa. 6,7 Lamivudine, an oral nucleoside analogue, is effective against both HIV and HBV replication. Lamivudine has promptly inhibited HBV replication in more than 80% of cases in both HIV-and non-HIV-infected patients. 8-10 However, HBV resistance to lamivudine caused by HBV-DNA polymerase gene mutations has been reported in both liver transplanted and immunocompetent patients. 8,[11][12][13][14][15][16][17] Incidence of HBV resistance to lamivudine is of 14% to 27% after 1 year of treatment in non-HIV-infected patients. 8,11 HBV resistance to lamivudine in HIV-infected patients has not been studied. We retrospectively analyzed a cohort of HIV-HBV-coinfected patients receiving lamivudine as a part of their antiretroviral therapy to study the long-term incidence of HBV resistance to lamivudine and to assess risk factors associated with this resistance. PATIENTS AND METHODSPatients. Studied patients belong to a cohort of 226 consecutive HBsAg carriers HIV-infected patients followed-up at our infectious diseases department since 1986. Patients were included if they fulfilled all the following criteria: (1) were receiving lamivudine (150 mg twice daily) as a part of antiretroviral therapy; (2) had a detectable serum HBV DNA by molecular hybridization at the beginning of lamivudine therapy. HBV-precore mutant infected patients (positive serum anti-HBe antibodies [HBeAb], negative HBeAg, and detectable serum HBV DNA) were also included; and (3) had serum HBV DNA and HBV-serological markers determinations at the second month of lamivudine therapy and at least twice during lamivudine therapy. Patients with hepatitis C or delta virus coinfections and those who had received a potent anti-HBV drug (ganciclovir, fosca...

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…Although 3TC is a potent anti-HBV agent [131], monotherapy is associated with a high likelihood of HBV resistance in coinfected persons (M204 V develops at a rate of 25%/year) and hence therapy with this drug, or FTC, without a second anti-HBV active drug is not recommended [132,133]. 3TC/FTC-resistant strains will normally respond to tenofovir [118][119][120][121][122][123][134][135][136][137] Tenofovir is effective at suppressing HBV DNA and may induce HBeAg seroconversion although, as for other antivirals in coinfection, this may be less likely than in an HIV-negative person [127,[134][135][136].…”

Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B

“…Tenofovir disoproxil fumarate (TDF), entecavir (ETV), emtricitabine (FTC), and lamivudine (LAM) are nucleotide/nucleoside(s) with activity against both HBV and HIV [55,56]. However, the rate of HBV resistance to lamivudine in HBV/HIV concurrently infected patients is high, reaching 90% at 4 years [57]. Hence, combination of a nucleoside and a nucleotide analogue should be the preferred association in order to prevent long-term resistance (TDF + LAM or FTC) [58].…”

Nomenclature for antiviral-resistant human hepatitis B virus mutations in the polymerase region

“…( An increasing number of treatment failures caused by antiviral resistance have been recognized since the introduction of antiviral agents like lamivudine (3TC, Epivir) for the treatment of chronic hepatitis B virus (HBV) infections. [1][2][3][4][5][6][7][8][9][10][11] In most cases amino acid variations in the reverse transcriptase (rt) domain of the HBV polymerase are apparent when compared with the pretreatment sequence. 12,13 Confusion has resulted from the varying amino acid numbering systems used in the different published studies.…”