Korean J Gastroenterol.  2008 Nov;52(5):325-328.

Development of Clevudine Resistance after Switching from Lamivudine in a Patient with Chronic Hepatitis B

• Koh KH
• Kang CJ
• Kim DH
• Choi YW
• Kim MJ
• Cheong JY
• Cho SW

Abstract

Clevudine is a nucleoside analog of the unnatural beta-L configuration which has potent antiviral activity against hepatitis B virus (HBV). Clevudine is expected to have similar pattern of resistance profile as lamivudine. However, there was no report on the mutation associated with clevudine resistance in patients with chronic hepatitis B. We report a case of young male patient with chronic hepatitis B who presented with clevudine resistance. The patient had received lamivudine therapy for 5 months with reduced serum HBV DNA levels. Then, lamivudine was switched to clevudine monotherapy. After the 6 months of clevudine therapy, the patient developed virologic breakthrough (>1.0x10(8) copies/mL) as well as biochemical breakthrough, which was associated with the presence of rtM204I plus rtL80I mutant. After switching from clevudine to adefovir, the viral load decreased with biochemical improvement.

Keyword

Chronic hepatitis B; Clevudine; Resistance

MeSH Terms

Adenine/analogs & derivatives/therapeutic use
Adult
Amino Acid Substitution
Antiviral Agents/*therapeutic use
Arabinofuranosyluracil/*analogs & derivatives/therapeutic use
Base Sequence
DNA, Viral/blood
Drug Resistance, Multiple, Viral
Hepatitis B e Antigens/metabolism
Hepatitis B, Chronic/*drug therapy/genetics
Humans
Lamivudine/*therapeutic use
Male
Phosphonic Acids/therapeutic use
Reverse Transcriptase Inhibitors/*therapeutic use