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Diagnosing and treating chronic hepatitis B virus (HBV) infection are key interventions to support progress towards elimination of viral hepatitis by 2030. Although nucleos/tide analogue (NA) therapy is typically highly effective, challenges remain for viral load (VL) suppression, including medication access, incomplete adherence and drug resistance. We present a case of a long-term HBV and HIV coinfected adult prescribed with sequential NA therapy regimens, with episodes of breakthrough viraemia. Multiple factors contribute to virological breakthrough, including exposure to old NA agents, initial high HBV VL, therapy interruptions, intercurrent illnesses and potential contribution from resistance mutations. The case underscores the importance of individualised treatment approaches and adherence support in achieving HBV suppression. Furthermore, it emphasises the need for improved clinical pathways addressing education, support and access to care, particularly for marginalised populations. Comprehensive data collection inclusive of under-represented individuals is crucial for maintaining retention in the care cascade and informing effective interventions.

Original publication

DOI

10.1136/sextrans-2024-056168

Type

Journal article

Journal

Sex Transm Infect

Publication Date

26/07/2024

Volume

100

Pages

329 - 331

Keywords

Antiviral Agents, HEPATITIS B, RESISTANCE, THERAPY, Adult, Humans, Middle Aged, Antiviral Agents, Coinfection, Drug Resistance, Viral, Guanine, Hepatitis B virus, Hepatitis B, Chronic, HIV Infections, Risk Factors, Viral Load, Viremia