Acute hepatitis B infection associated with drug-resistant hepatitis B virus

Abstract Background Pre-existing antiviral- resistant hepatitis Bvirus (HBV) has been associated with primary non-response to lamivudinetreatment in patients with chronic hepatitis B, but little is known of the capacity for resistantHBV to cause primary infection. Objective The study was to investigate if Beijing patients with acute hepatitis B(AHB) are infected with drug- resistantHBV. Study design Sera were collected from 201 NA-untreated patients with AHB. Direct polymerase chain reaction (PCR) sequencing was used to screen HBV reverse-transcriptase (RT) domain and clonal sequencing were performed for all resistance-positive samples. Results Direct PCR sequencing showed that 14 samples (7.0%) were positive for drug- resistantHBV variants, comprised of 11 with the lamivudine- resistantpattern rtM204I and/or rtM204V in the presence and absence of compensatory mutations rtL80I, rtV173L, and rtL180M; two with the adefovir- resistantpattern rtA181V; and one with the entecavir- resistantpattern rtL180M + rtS202G + rtM204V. Concomitance of resistancevariants with wild-type HBV was observed in samples from 13 patients. Clonal sequencing verified direct sequencing results. Furthermore, variants associated with resistanceto adefoviror entecavirwere found in 3 samples. Conclusions Drug- resistantHBV strains, including those not resistantto lamivudine, are transmissible and can cause acute hepatitis Bin China.