Pyrosequencing proved to be a powerful tool for detecting co-circulating strains in a complex population. This allowed resistant HBV to be detected before any evidence of virological or biochemical breakthrough, thus increasing the possibility of a correct choice of rescue therapy and increasing the likelihood of successful treatment. Interestingly, all but two individuals whose major virus population was composed of WT isolates and a small percentage of resistant variants detected by pyrosequencing had a YIDD

variant as a minor subpopulation, suggesting that the rtM204I mutation may naturally occur more often and replicate more efficiently than YVDD variants in environments with little or no selection pressures. The only LY2835219 in vivo disagreement between the results of direct sequencing and pyrosequencing was for sample NN124. The direct sequencing method detected GDC-0449 cell line nucleotides (GTG) coding for rt204V, although the electropherogram indicated DNA Damage inhibitor mixtures with small quantities of nucleotides A and T corresponding to the first and third position, respectively, of codon rt204I (Figure 2A). In contrast, pyrosequencing indicated a majority (~60%) of rt204I variant and about 40% rt204V variant (Figure 2B). The same discrepant results were also obtained when the segment used as template for the direct sequencing method was amplified using pyrosequencing primers. This disagreement may be attributable to the

similar amounts of YIDD and YVDD variants

(60% vs. 40%) reported by pyrosequencing. Figure 2 Discrepancy between direct sequencing and pyrosequencing in sample NN124. The direct sequencing method (A) detected the nucleotides (GTG) coding for the rtM204V variant, although the electropherogram indicated mixtures with small quantities Cediranib (AZD2171) of nucleotides A and T corresponding to the first and third nucleotide position of codon ATT (rt204I). Pyrosequencing (B) detected about 60% YIDD (I/ATT) and 40% YVDD (V/GTG) variants Conclusions Pyrosequencing is a rapid, specific, and sensitive tool that may be useful in detecting and quantifying subpopulations of resistant viruses. Here, YMDD variants were frequently detected by this method as a minor population in acute HBV infection. Co-circulation of mixtures of WT and mutant isolates of YMDD variants was frequently revealed in treated, chronic hepatitis patients by pyrosequencing. Detection of YMDD variants before their detection by conventional sequencing methods might contribute to making more informed drug choices and thus improving the outcome of therapy. Acknowledgments The authors thank the Plataforma Genômica – Seqüenciamento de DNA/PDTIS-FIOCRUZ for performing the DNA sequencing. Financial support: PAPES/CNPq. References 1. Yuen LK, Locarnini SA: Genetic variability of hepatitis B virus and response to antiviral treatments: searching for a bigger picture. J Hepatol 2009, 50:445–448.PubMedCrossRef 2.