R. Ling et al., SELECTION OF MUTATIONS IN THE HEPATITIS-B VIRUS POLYMERASE DURING THERAPY OF TRANSPLANT RECIPIENTS WITH LAMIVUDINE, Hepatology, 24(3), 1996, pp. 711-713
We describe mutations in the hepatitis B virus (HBV) polymerase gene i
n viruses which reactivated in two patients during therapy with -2'-de
oxy-3'-thiacytidine, or lamivudine (3TC), and following orthotopic Liv
er transplantation for chronic hepatitis B. Virus resistance to 3TC is
associated with mutations which lead to amino acid substitutions in t
he highly conserved tyr-met-asp-asp (YMDD) motif, part of the active s
ite of the polymerase, and which parallel those seen in resistant huma
n immunodeficiency virus (HIV) Substitutions of valine and isoleucine
for methionine were found in the two cases. The significance of single
secondary mutations, which differ between viruses from the two patien
ts, remains to be determined. Thus, viral resistance to lamivudine of
hepatitis B virus mimics that of HIV and can occur in the setting of i
mmunosuppression after liver transplantation.