Several mutations (V521L, P525L, L528M, T532S, and V555I) in the gene for hepatitis B virus (HBV) polymerase have been identified in HBV isolated from patients that displayed break-through viremia during famciclovir treatment. To determine whether these mutations cause phenotypic resistance to famciclovir, we compared the inhibition constants (K i ) of penciclovir triphosphate (PCVTP, the active metabolite of famciclovir) for recombinant wild-type and mutant HBV polymerases containing these mutations. In in vitro enzymatic assays, the V555I mutation displayed the most resistance (with K i increased by 6.2-fold) to PCVTP. The V521L and L528M mutations showed moderately decreased sensitivity to PCVTP (K i increased by G3-fold). We also analyzed the cross-resistance profiles of these variants for adefovir and lamivudine, two other antiviral agents that also inhibit DNA replication by HBV polymerase. All 5 famciclovir-associated mutations were sensitive to adefovir diphosphate (ADVDP) in in vitro enzymatic assays (F2.3-fold decreased sensitivity). The V521L, L528M, and T532S mutations were also sensitive to lamivudine triphosphate (LAMTP); however, the P525L and V555I mutations displayed moderately decreased sensitivity to LAMTP in enzymatic assays (3.6-fold decreased sensitivity). The lamivudine-resistant mutations M552I, M552V, and L528MΨM552V, which were previously shown to display 8-to 25-fold resistance to LAMTP, were less resistant (I3.1-fold) to PCVTP. (HEPATOLOGY 2000;31:219-224.) Hepatitis B viral infection is a major cause of acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma, and it is one of the 10 most common causes of death worldwide. 1 Current treatment regimens rely primarily on interferon alfa therapy. However, interferon has limited efficacy, is expensive, requires parenteral administration, and is associated with frequent and unpleasant side effects. Nucleoside or nucleotide analogs, which inhibit DNA replication through hepatitis B virus (HBV) polymerase, represent a new Abbreviations: HBV, hepatitis B virus; dGTP, deoxyguanosine triphosphate; HIV, human immunodeficiency virus; HBsAg, hepatitis B surface antigen; dNTP, deoxynucleotide triphosphate; dATP, deoxyadenosine triphosphate; dCTP, deoxycytidine triphosphate; dTTP, deoxythymidine triphosphate; K m , Michaelis constant; K i , inhibition constant; PCVTP, penciclovir triphosphate; ADVDP, adefovir diphosphate; LAMTP, lamivudine triphosphate.
From Gilead Sciences, Foster City, CA.