核酸アナログ未使用のB型慢性肝炎症例へのエンテカビル治療中にrtA181T変異ウイルスが増殖した1症例

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A 51-year-old Japanese woman with chronic hepatitis B who had never treated with nucleotide analogues was admitted to our hospital and treated with entecavir. In this patient, entecavir successfully reduced the HBV level, but viral and biochemical breakthrough was observed at 10 months after the beginning of therapy. The HBV viral load reached up to 8.2 log copies/ml, but direct sequence analysis showed no LAM and ETV resistant-related mutation (rtT184, S202, M204, M250). Comparison by clonal analysis of samples obtained before and after the viral breakthrough showed the increase of the rtA181T mutant strains (8.5% versus 39.5%). It was considered that the rtA181T mutant strain in this case might be related to entecavir resistance.