Selection of multiple mutations in precore, core promoter and polymerase in a chronic HBV infected patient during long-term course of antiviral therapy

We report a case of a chronically HBV-infected, HBeAg+, genotype D male patient with histological evidence of advanced liver disease. At baseline, HBV-DNA titres and HBsAg level in serum were 2×106 copies/ml and 10µg/ml(Laurell), respectively. Levels of intrahepatic DNAs (total 8,2 copies/cell, cccDNA 0,04 copies/cell) indicated moderate viral activity. Coexistence of variants harbouring precore (pc) and core promoter (cp) mutations along with wild-type (wt) strains was shown using Innolipa hybridisation assay. Antiviral therapy was started with PEG-IFN a2b (1,5ug/kg) and Adefovir 10mg (ADV). After 48 weeks HBeA…