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Fatal hepatitis B virus reactivation due to a lamivudine mutant despite undetectable initial viral load.

In patients with chronic hepatitis B virus (HBV) infection chemotherapy has been associated with high risk of reactivation. All HBV carrier candidates for chemotherapy must receive pre-emptive therapy with nucleos(t)ides; European Clinical Practice guidelines recommend lamivudine in patients with low or undetectable initial HBV DNA levels [1]. However, the clinical importance of lamivudine-resistant mutants emerging in immunosupressed patients has not been adequately explored [2,3].