Case Report

A case of entecavir resistance which is developed after complete viral suppression during entecavir treatment for nucleoside-naive chronic hepatitis B

Volume 25 · Issue 1 Publish Date: February 15, 2014
Ümit Bilge Doğan Agah Bahadır Öztürk Mustafa Salih Akın Serkan Yalaki Murat Sayan
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Turkish Journal of Gastroenterology

Volume 25 · Issue 1

Pages: 206-209

History

Published Online: February 15, 2014

Copyright © 2014 Ümit Bilge Doğan, Agah Bahadır Öztürk, Mustafa Salih Akın, Serkan Yalaki, Murat Sayan

Ümit Bilge Doğan
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
Agah Bahadır Öztürk
Department of Family Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
Mustafa Salih Akın
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
Serkan Yalaki
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana
Murat Sayan
Department of Clinical Laboratory, Kocaeli University Medical Faculty Hospital, Kocaeli, Turkey
Doğan, Ümit B., Öztürk, A. B., Akın, M. S., Yalaki, S., & Sayan, M. (2014). A case of entecavir resistance which is developed after complete viral suppression during entecavir treatment for nucleoside-naive chronic hepatitis B. Turkish Journal of Gastroenterology, 25(1), 206–209. https://doi.org/10.5152/tjg.2014.3605
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Abstract

Abstract Entecavir (ETV) is a potent nucleoside analogue against hepatitis B virus (HBV), and the emergence of drug resistance is rare in nucleoside-naive patients because development of ETV resistance (ETVr) requires at least three amino acid substitutions in HBV reverse transcriptase. We observed a case of genotypic ETVr with viral and biochemical breakthrough during ETV treatment of nucleoside-naive patients with chronic hepatitis B (CHB). A 57-years-old HBeAg-positive man received ETV 0.5 mg/day for 145 weeks. HBV DNA was 7.7 log10 copies/ ml at baseline, decreased to below 2 at week 48, declined to a nadir of 0 (negative) at week 72, and rebounded to 2.2 log10 copies/ ml at week 90 and remained this level until 109 weeks and increased to 6.8 log10 copies/ ml at week 145. Alanine aminotransferase (ALT) level increased to 440 IU/ L at week 145. The ETVr-related substitution (rtS202P) and lamivudine resistance-related substitutions (rtL180M + rtM204V) were detected by DNA sequencing analysis at week 145. The patient discontinued ETV therapy at week 145, and then received 245 mg of tenofovir disoproxil fumarate (TDF). Afterwards, HBV DNA level dropped to below 2.6 log10 copies/ml and ALT level was normalized after 19 weeks of TDF dosing. The three substitutions associated with ETV and lamivudine resistance developed after complete viral suppression in a nucleoside-naive CHB patient during ETV treatment. In spite of the extremely rare chance of viral mutation during ETV treatment, nucleoside-naive patients should be carefully monitored for resistance even if complete suppression is present.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 25 · Issue 1
Pages 206-209
DOI 10.5152/tjg.2014.3605
History
Published Online February 15, 2014
Copyright
Copyright (c) 2014 Ümit Bilge Doğan, Agah Bahadır Öztürk, Mustafa Salih Akın, Serkan Yalaki, Murat Sayan
Affiliations
Ümit Bilge Doğan
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
Agah Bahadır Öztürk
Department of Family Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
Mustafa Salih Akın
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
Serkan Yalaki
Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana
Murat Sayan
Department of Clinical Laboratory, Kocaeli University Medical Faculty Hospital, Kocaeli, Turkey
Cite this Article
Doğan, Ümit B., Öztürk, A. B., Akın, M. S., Yalaki, S., & Sayan, M. (2014). A case of entecavir resistance which is developed after complete viral suppression during entecavir treatment for nucleoside-naive chronic hepatitis B. Turkish Journal of Gastroenterology, 25(1), 206–209. https://doi.org/10.5152/tjg.2014.3605
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