Reactivation of hepatitis B e antigen-negative chronic hepatitis B in a bone marrow transplant recipient following lamivudine withdrawal

Reactivation of hepatitis B virus (HBV) is a recognized complication of bon e marrow transplantation (BMT). Lamivudine is a nucleoside analogue with po tent antiviral activity that has been used in the prophylaxis of HBV reacti vation in at-risk BMT recipients. Currently, no data exist regarding the sa fety of nucleoside analogue withdrawal in these patients. A 32,year-old BMT recipient with hepatitis B e antigen (HBeAg) -negative, chronic HBV who de veloped a serious flare of hepatic inflammation due to a rebound in viral r eplication within 12 weeks of discontinuing lamivudine therapy is described . The patient remained HBeAg-negative despite high level viremia, suggestin g the emergence of a mutant viral strain. The patient's acute hepatitis res olved promptly with the reinstitution of lamivudine therapy. Further studie s are necessary to define the safety and efficacy of nucleoside analogues i n the prevention of HBV reactivation in at-risk BMT recipients. Clinicians should consider the risk of inducing serious flares of hepatic inflammation due to abrupt nucleoside analogue withdrawal in these patients.