Lamivudine resistance in untreated chronic hepatitis B patients in Turkey

Turk J Gastroenterol. 2008 Jun;19(2):99-103.

Abstract

Background/aims: Hepatitis B virus infection is an epidemiological problem throughout the world, including in Turkey. Lamivudine is one of the hepatitis B virus reverse-transcriptase inhibitors used for the treatment of chronic hepatitis B virus infection. Lamivudine resistance can develop not only following treatment; it can also be seen in untreated patients. This resistance is related with structural changes in the tyrosine-methionine- aspartate-aspartate motif of the polymerase enzyme gene. Our objective was to evaluate the prevalence of lamivudine resistance in Turkish chronic hepatitis B virus-infected patients with D genotype before antiviral treatment.

Methods: Seventyseven patients with chronic hepatitis B virus infection were evaluated for viral loads, HBeAg, anti-HBe antibody, ALT levels, histological activity index, and tyrosine-methionine-aspartateaspartate mutations.

Results: Tyrosine-methionine-aspartateaspartate motif mutations were determined in 3 of 24 HBeAg positive and 3 of 53 anti-HBe positive patients with a rate of 7.8%. Two of the mutations were YIDD and 4 were YVDD. Median ALT value in patients with mutations was 88 IU/L (range 55-276) and histological activity index was 9 (range 6-10); these values in patients without mutations were 58 (range 19- 176) and 10 (range 2-18), respectively. Knodell fibrosis scores of patients were as follows: 0: 13.2%, 1: 28.9%, 2: 21.1%, 3: 34.2%, and 4: 2.6%. There were no significant differences between the patients regarding Knodell fibrosis scores. One patient was diagnosed as cirrhosis.

Conclusions: Evaluation of chronic hepatitis B virus patients for lamivudine resistance and planning the treatment accordingly may prevent complications and can increase the effectiveness of the treatment.

MeSH terms

  • Adolescent
  • Adult
  • Amino Acid Motifs / genetics
  • Child
  • Child, Preschool
  • DNA Mutational Analysis / statistics & numerical data
  • DNA, Viral / genetics
  • Drug Resistance, Viral / genetics*
  • Female
  • Genotype
  • Hepatitis B virus / genetics*
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / virology*
  • Humans
  • Lamivudine / therapeutic use*
  • Liver / pathology
  • Liver / virology
  • Male
  • Middle Aged
  • Mutation
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Turkey
  • Viral Load
  • Young Adult

Substances

  • DNA, Viral
  • Reverse Transcriptase Inhibitors
  • Lamivudine