Hepatitis B exacerbation with a precore mutant virus following withdrawal of lamivudine in a human immunodeficiency virus-infected patient

Chronic active hepatitis B exacerbations have been reported following devel opment of resistance to or withdrawal of lamivudine in HIV-infected patient s. A 38-year-old woman with HIV and chronic HBV infections was hospitalized because of acute hepatitis. The occurrence of cytolysis with replication o f HBV 2 months after withdrawing lamivudine suggests that our patient exper ienced a severe reactivation of HBV infection due to the modification of he r treatment. Sequencing of the HBV precore region showed the strain to be a mutant. We conclude that lamivudine should not be stopped in HIV- and HBV- infected patients, but could be continued at the dose of 100 mg/day as used in isolated HBV infection. (C) 2000 The British Infection Society.