Journal Article

Failure of Combination Therapy with Lamivudine and Famciclovir following Lamivudine Monotherapy for Hepatitis B Virus Infection in Patients Coinfected with Human Immunodeficiency Virus-1

Gail V. Matthews, Deenan Pillay, Patricia Cane, Daina Ratcliffe, Brian Gazzard and Mark Nelson

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 33, issue 12, pages 2049-2054
Published in print December 2001 | ISSN: 1058-4838
Published online December 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/322655
Failure of Combination Therapy with Lamivudine and Famciclovir following Lamivudine Monotherapy for Hepatitis B Virus Infection in Patients Coinfected with Human Immunodeficiency Virus-1

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Individuals coinfected with human immunodeficiency virus 1 (HIV-1) and hepatitis B virus (HBV) often receive treatment with an antiretroviral regimen including lamivudine. Lamivudine monotherapy for HBV may lead to drug-resistant mutations in a significant number of patients. The virological and biochemical responses of 8 patients coinfected with HBV/HIV-1 treated with both lamivudine and famciclovir were studied. Patients exhibiting HBV viral rebound at 1 year were analyzed for the emergence of HBV polymerase mutations. Only 1 patient had no prior exposure to lamivudine. Addition of famciclovir to the treatment regimen resulted in a median fall in HBV DNA level of 0.33 log10 at 3 months and an overall rise in HBV DNA level of 3 log10 at 12 months. The only patient in whom durable viral suppression and HBV e antigen seroconversion were noted began receiving lamivudine and famciclovir simultaneously. HBV polymerase gene sequencing identified resistance-associated mutations in 6 of 7 patients with viral rebound. Sequential nucleoside analogue therapy is unlikely to be successful in achieving long-term suppression of HBV replication, and combination therapy should be considered at treatment initiation.

Journal Article.  3440 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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