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Emergence of lamivudine resistance hepatitis B virus mutations in pregnant women infected with HBV and HIV receiving antiretroviral prophylaxis for the prevention of mother‐to‐infant transmission in Malawi
Author(s) -
Galluzzo Clementina,
Liotta Giuseppe,
Andreotti Mauro,
Luhanga Richard,
Jere Haswell,
Mancinelli Sandro,
Maulidi Martin,
Sagno JeanBaptiste,
Pirillo Maria,
Erba Fulvio,
Amici Roberta,
Ceffa Susanna,
Marazzi Maria Cristina,
Vella Stefano,
Palombi Leonardo,
Giuliano Marina
Publication year - 2012
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.23365
Subject(s) - lamivudine , virology , hepatitis b virus , nevirapine , zidovudine , medicine , stavudine , hbeag , transmission (telecommunications) , hepatitis b , hbsag , virus , immunology , viral load , viral disease , antiretroviral therapy , electrical engineering , engineering
HIV/HBV co‐infection is highly prevalent in sub‐Saharan Africa. The aim of this study was to determine if the use of triple combination lamivudine‐containing prophylaxis for the prevention of mother‐to‐infant HIV transmission was associated with the emergence of lamivudine HBV mutations. The study included 21 pregnant co‐infected women in Malawi who received either zidovudine or stavudine plus lamivudine and nevirapine from week 25 of gestation until 6 months after delivery or indefinitely if they met the criteria for treatment (CD4+ <350/mm 3 ). HBV‐DNA was determined using the Roche COBAS assay. Resistance mutations were assessed by the Trugene assay (Siemens Diagnostics). At baseline 33% of the women were HBeAg positive and had HBV‐DNA > 10 4 IU/ml. Median CD4 count was 237 cells/mm 3 and median HIV‐RNA was 3.8 log 10 copies/ml. After a median of 259 days of treatment, HBV‐DNA was detectable in 9 out of 21 patients (42.8%). In three cases the HBV‐DNA level was >10 4 IU/ml. Resistance mutations (M204I in five cases and L180M + M204I/V in one case) were present in 6 (28.6%) patients. Women with a resistant virus had significantly higher baseline HBV‐DNA levels than those not developing resistance (1.1 × 10 7 IU/ml vs. 20.8 IU/ml, P = 0.022). Levels of ALT and AST were higher in women with resistant viruses compared to those retaining a wild‐type virus. A high rate of lamivudine resistance was seen in this cohort of pregnant women. Follow‐up of these patients will clarify if the presence of resistance has a significant impact on liver disease. J. Med. Virol. 84:1553–1557, 2012. © 2012 Wiley Periodicals, Inc.