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Molecular analysis of hepatitis B virus (HBV) in an HIV co-infected patient with reactivation of occult HBV infection following discontinuation of lamivudine-including antiretroviral therapy

Andrea Costantini1, Katia Marinelli2, Giulia Biagioni2, Alessia Monachetti2, Monica L Ferreri2, Luca Butini1, Maria Montroni1, Aldo Manzin3 and Patrizia Bagnarelli2*

Author Affiliations

1 Clinical Immunology Unit, Department of Clinical and Molecular Sciences, Università Politecnica Marche, Via Tronto 10/a, 60020 Ancona, Italy

2 Virology Unit, Department of Biomedical Sciences and Public Health, Università Politecnica Marche, Via Tronto 10/a, 60020 Ancona, Italy

3 Section of Medical Microbiology, Department of Biomedical Science and Technology, Università di Cagliari, S.S.554, Bivio per Sestu, 09124 Monserrato (CA), Italy

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BMC Infectious Diseases 2011, 11:310  doi:10.1186/1471-2334-11-310

Published: 4 November 2011



Occult hepatitis B virus (HBV) infection (OBI) is characterized by HBV DNA persistence even though the pattern of serological markers indicates an otherwise resolved HBV infection. Although OBI is usually clinically silent, immunocompromised patients may experience reactivation of the liver disease.

Case presentation

We report the case of an individual with human immunodeficiency virus (HIV) infection and anti-HBV core antibody positivity, who experienced severe HBV reactivation after discontinuation of lamivudine-including antiretroviral therapy (ART). HBV sequencing analysis showed a hepatitis B surface antigen escape mutant whose presence in an earlier sample excluded reinfection. Molecular sequencing showed some differences between two isolates collected at a 9-year interval, indicating HBV evolution. Resumption of ART containing an emtricitabine/tenofovir combination allowed control of plasma HBV DNA, which fell to undetectable levels.


This case stresses the ability of HBV to evolve continuously, even during occult infection, and the effectiveness of ART in controlling OBI reactivation in HIV-infected individuals.