Article
Novel mutation in YMDD motif and direct neighbourhood in a child with chronic HBV-infection and clinical lamivudine and adefovir resistance – a scholarly case
Identifizierung einer neuen Mutation im YMDD motif bei einem pädiatrischen Patienten mit chronischer HBV-Infektion und klinischer Lamivudin- und Adefovir-Resistenz
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Authors
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V. Schildgen
- Universität Bonn, Germany
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S. Ziegler
- Universität Bonn, Germany
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R.L. Tillmann
- Universität Bonn, Germany
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O. Schildgen
- Universität Bonn, Institut für Virologie, Bonn, Germany; Kliniken der Stadt Köln gGmbH, Institut für Pathologie, Köln, Germany
| Published: | June 2, 2010 |
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Outline
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Context: Chronic HBV infection is a major cause of hepatocellular carcinoma (HCC) which meanwhile has become the 5th most reason for a fatal outcome of cancer. Worldwide, approximately 350 million people are chronically HBV infected and as such of risk to develop HCC. Treatment of chronic infection is sufficient to reduce the rate of HCC but the rate of sustained virological response remains to low, not at least due to emergence of resistant virus strains. Less is known on HBV infection in children despite the extremely high rate of chronicity.
Objective, design, setting, and patient: The case of a nine years old male with a 6 year history of chronic HBV infection, of those 5 years with antiviral treatment.
Interventions and main outcome measure(s): Before our lab was consulted, the patient was unsuccessfully treated with interferon, an obscure drug named Hepon, which should activate antiviral immune response, and Lamivudine, the latter becoming ineffective due to the mergence of resistant subpopulations. Replacement of Lamivudine by adefovir displayed no advantage despite the lack of resistance mutations.
Results: Novel mutations in the YMDD motif and its direct neighbourhood were observed, both being compatible with Lamivudine resistance. No mutations were found that are associated with ADF resistance.
