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Original article

Lamivudine-resistant HBV infection in HIV-positive patients receiving antiretroviral therapy in a public routine clinic in Cameroon

Charles Kouanfack, Avelin F Aghokeng, Anne-Marie Mondain, Anke Bourgeois, Alain Kenfack, Eitel Mpoudi-Ngolé, Jacques Ducos, Eric Delaporte, Christian Laurent

Corresponding author name: Christian Laurent
Corresponding author e-mail: Christian.Laurent@ird.fr

Citation: Antiviral Therapy 2012; 17:321-326
doi: 10.3851/IMP1911

Date accepted: 30 May 2011
Date published online: 23 September 2011

Abstract

Background: In Africa, most HIV–HBV-coinfected patients on antiretroviral therapy (ART) receive an anti-HBV lamivudine monotherapy that has been shown in northern countries to lead to frequent emergence of drug resistance. We assessed the HBV prevalence and the rate and pattern of lamivudine-resistant HBV mutations in Cameroonian HIV-infected, ART-treated patients.

Methods: A cross-sectional survey was performed in 2006–2007 at the HIV/AIDS outpatient clinic of the Central Hospital in Yaoundé, Cameroon. Plasma samples were tested as appropriate for hepatitis B surface antigens, antibodies to hepatitis B core, HBV DNA, genotypes and lamivudine-resistant polymerase mutations.

Results: Of 552 adult patients (71% women, median age 38 years), 290 had received lamivudine-based ART for 12 months and 262 for 24 months. No patient had received tenofovir. The prevalence of hepatitis B surface antigen was 9.8%. Overall, 26% of seropositive patients had an HBV DNA level >40 IU/ml. Genotypes A and E were identified. Polymerase resistance mutations were detected in 14% and 60% of patients at months 12 and 24, respectively.

Conclusions: This study supports both WHO recommendations of screening for HBV before initiation of ART and of using ART containing tenofovir and either lamivudine or emtricitabine in HIV–HBV-coinfected patients in Africa.

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