Abstract
Tenofovir disoproxil fumarate (TDF) is a potent anti–hepatitis B virus (HBV) agent and is recommended as the first-line therapy of HBV infection in HIV-coinfected patients.1,2 However, 8%–11% of patients will experience persistent HBV viremia despite up to 5 years of TDF treatment.3,4 The impact of persistent HBV viremia on the generation of HBV drug resistance during TDF treatment is not known. As lamivudine (3TC) monotherapy in HIV-HBV infection is associated with 3TC resistance in up to 90% of patients after 4 years,5 ongoing viremia despite HBV therapy raises concern for driving development of TDF and/or 3TC resistance. Therefore, intensification with entecavir (ETV) has been used by some clinicians with the rationale of reducing HBV drug resistance and preventing progression of liver disease associated with ongoing HBV viremia.6 In a pilot study, we characterized HBV resistance mutations among adults with persistent HBV viremia after 48 weeks of TDF and 3TC/emtricitabine (FTC) treatment and evaluated virologic response among patients with and without subsequent ETV intensification.
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