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

BMC Infect Dis. 2011 Nov 4;11:310. doi: 10.1186/1471-2334-11-310.

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.

Case presentation: 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.

Conclusion: 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.

Publication types

  • Case Reports

MeSH terms

  • Antiretroviral Therapy, Highly Active / methods*
  • Antiviral Agents / administration & dosage*
  • DNA, Viral / chemistry
  • DNA, Viral / genetics
  • Evolution, Molecular
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Hepatitis B Surface Antigens / genetics
  • Hepatitis B virus / classification*
  • Hepatitis B virus / genetics*
  • Hepatitis B virus / immunology
  • Hepatitis B virus / isolation & purification
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / virology*
  • Humans
  • Lamivudine / administration & dosage*
  • Middle Aged
  • Molecular Sequence Data
  • Mutation, Missense
  • Sequence Analysis, DNA

Substances

  • Antiviral Agents
  • DNA, Viral
  • Hepatitis B Surface Antigens
  • Lamivudine

Associated data

  • GENBANK/JF827279
  • GENBANK/JF827280