Virology and clinical sequelae of drug-resistant HBV in HIV - HBV-coinfected patients on highly active antiretroviral therapy

Several of the nucleoside/nucleotide analogues used to treat HIV also inhibit HBV replication, with lamivudine being the oldest of this group. Thus, prior to licensing of tenofovir, many HIV - HBV-coinfected individuals received lamivudine as the only drug active against HBV as part of an anti-HIV regimen, which set the stage for the emergence of drug-resistant HBV. In coinfected persons, lamivudine-resistant HBV develops more rapidly than in HBV-moninfected persons, but it is not known if this is true for the newer agents. Owing to overlapping reading frames of the HBV polymerase and surface antigens, drug-resistant changes in HBV Pol can lead to mutations in the envelope. This review will discuss studies of drug-resistant HBV in HIV-infected persons including drug-resistant mutations that have been identified and clinical sequelae of these mutations.