A case report of successful therapy with tenofovir for a multi-drug resistant chronic hepatitis B patient complicated with malignant lymphoma

Abstract

A 33-year-old man who diagnosed with malignant lymphoma was treated with lamivudine (LVD) for chronic hepatitis B in 2001. Because he experienced the first breakthrough hepatitis in 2005, adefovir (ADV) was added to the LVD regimen for dual therapy. In September 2007, LVD plus ADV combination therapy was replaced by entecavir (ETV) monotherapy. Eight months later, in May 2008, hepatitis B virus (HBV) DNA level elevated, followed by the second breakthrough hepatitis. After then, switching from ETV to LVD plus ADV could not suppress HBV-DNA level and ALT flare because sequencing analysis showed the evidence of multiple drug resistance with L80I, L180M, A181T, T184I and M204I/V mutations. In this case, after getting the approval of the ethical committee, we applied him the combination therapy with LVD and tenofovir (TDF), that decreased the serum HBV DNA and ALT concentration within a few months and obtained the complete remission of malignant lymphoma by allogenic bone marrow transplantation.