Article Text

Download PDFPDF
Multiple risk factors for persistent HBV viraemia in an adult receiving nucleos/tide analogue therapy
  1. Sheila Lumley1,
  2. Maeve Barlow2,
  3. Khadija Said3,4,
  4. Emily Martyn3,4,
  5. Elizabeth Waddilove3,
  6. Marion Delphin3,
  7. Daisy Jennings1,
  8. Haiting Chai1,
  9. Agnes Kemper2,
  10. Joy Ko2,
  11. Azim Ansari1,
  12. Douglas Macdonald5,
  13. Indrajit Ghosh2,
  14. Samreen Ijaz6,
  15. Stuart Flanagan2,
  16. Philippa Clare Matthews2,3
  1. 1Nuffield Departmnet of Medicine, University of Oxford, Oxford, UK
  2. 2Central North West London NHS Foundation Trust, London, UK
  3. 3Francis Crick Institute, London, UK
  4. 4University College London, London, UK
  5. 5Royal Free Hospital, London, UK
  6. 6Virus Reference Department, National Infection Service, UK Health Security Agency-Colindale, London, UK
  1. Correspondence to Dr Sheila Lumley, University of Oxford, Oxford, UK; sheila.lumley{at}


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.

  • Antiviral Agents

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Anna Maria Geretti

  • X @pippa_matt

  • Contributors SL and PCM are the guarantors.

  • Funding SL is funded by a Wellcome clinical PhD fellowship (102176/B/13/Z). PCM has funding from Wellcome (reference: 110110/Z/15/Z), the Francis Crick Institute and UCL NIHR Biomedical Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.