Abstract
Breakthrough hepatitis is common during lamivudine treatment for chronic hepatitis B, and usually develops before HBeAg seroconversion. We encountered a patient who received lamivudine due to acute exacerbation of chronic hepatitis B. Liver function tests became normalized gradually and HBeAg seroconversion was attained 6 months after the start of treatment. While lamivudine treatment was extended in order to ensure the response durability, breakthrough hepatitis accompanying the emergence of drug-resistant mutant (methionine-to-valine substitution at tyrosine-methionine-aspartate-aspartate motif of the HBV polymerase gene) occurred at the 10th month of therapy. G-to-A substitution at nucleotide 1896 of the precore region was detected at the same time. Our experience warrants attention in that the advocacy for additional lamivudine treatment to consolidate HBeAg seroconversion needs to be balanced against increasing risk of emerging resistant mutants.
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