Virological Response to Lamivudine and Tenofovir Treatment in a Mono-infected Chronic Hepatitis B Patient with Potential Tenofovir Resistance: A Case Report.

IF 3.1 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Clinical and Translational Hepatology Pub Date : 2025-01-28 Epub Date: 2024-12-12 DOI:10.14218/JCTH.2024.00248
Monica Dahiya, Teresa Tai, Trana Hussaini, Gordon Ritchie, Nancy Matic, Eric M Yoshida, Christopher F Lowe
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Abstract

Few cases of tenofovir resistance have been reported, and the appropriate treatment for such cases remains unclear. We aimed to share a case of a chronic hepatitis B mono-infected patient with potential tenofovir resistance who required combined lamivudine and tenofovir therapy to achieve adequate viral suppression. The patient's viral load (plasma) was monitored using the cobas® hepatitis B virus Test on the cobas® 6800 system. Hepatitis B antiviral drug resistance (AVDR) mutations were assessed by amplicon-based sequencing. Plasma was extracted using the MagNa Pure 24 system, and polymerase chain reaction targeting the polymerase gene (860bp) was performed. Sequencing was conducted on GridION R10.4.1 flow cells, and the resulting FASTQ files were analyzed using DeepChek®-HBV Software. We describe a female patient in her 60s with chronic hepatitis B who was e-antigen positive. She met treatment criteria in May 2020, when her alanine transaminase levels were 1.5 times above the upper limit of normal. She was initially started on entecavir but had to switch to tenofovir alafenamide in June 2020 due to a rash. Despite three years of tenofovir therapy, her viral load remained unsuppressed. AVDR testing identified two suspected tenofovir resistance mutations (V191I and A317S). Since no mutations associated with lamivudine resistance were detected, the patient was treated with a combination of lamivudine and tenofovir, achieving viral suppression after four months. Although rare, tenofovir resistance should be considered in patients with persistent viremia despite long-term therapy. AVDR sequencing facilitated the detection of potential tenofovir resistance and guided treatment decisions, leading to successful viral suppression in this case.

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拉米夫定和替诺福韦治疗对一名可能对替诺福韦耐药的单感染慢性乙型肝炎患者的病毒学反应:一例报告。
很少有替诺福韦耐药的病例报告,对此类病例的适当治疗仍不清楚。我们的目的是分享一例慢性乙型肝炎单感染患者,潜在的替诺福韦耐药,需要拉米夫定和替诺福韦联合治疗以达到充分的病毒抑制。采用cobas®6800系统进行cobas®乙型肝炎病毒检测,监测患者的病毒载量(血浆)。乙型肝炎抗病毒药物耐药性(AVDR)突变通过基于扩增子的测序进行评估。采用MagNa Pure 24系统提取血浆,针对聚合酶基因(860bp)进行聚合酶链反应。对GridION R10.4.1流式细胞进行测序,使用DeepChek®-HBV软件分析FASTQ文件。我们描述了一位60多岁的女性慢性乙型肝炎患者,e抗原阳性。她在2020年5月符合治疗标准,当时她的丙氨酸转氨酶水平超过正常上限的1.5倍。她最初开始使用恩替卡韦,但由于皮疹,她不得不在2020年6月改用替诺福韦阿拉芬胺。尽管接受了三年的替诺福韦治疗,她的病毒载量仍未受到抑制。AVDR检测发现了两个疑似替诺福韦耐药突变(V191I和A317S)。由于没有检测到与拉米夫定耐药相关的突变,因此患者接受了拉米夫定和替诺福韦联合治疗,4个月后实现了病毒抑制。尽管罕见,但在长期治疗的持续性病毒血症患者中应考虑替诺福韦耐药。AVDR测序有助于发现潜在的替诺福韦耐药性并指导治疗决策,从而在该病例中成功抑制病毒。
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来源期刊
Journal of Clinical and Translational Hepatology
Journal of Clinical and Translational Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.40
自引率
2.80%
发文量
496
期刊最新文献
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