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Lamivudine Resistance in Iranian Chronic Hepatitis B Patients


1 Gastroenterintestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firuzgar Hospital, Tehran, Iran
2 Baqiyatallah Research Center for Gastroenterology and Liver Disease. Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Department of Virology, Iran University of Medical Sciences, Tehran, Iran
*Corresponding Author: F Fallahian , Gastroenterintestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firuzgar Hospital, Vali asr Square, Aban St., Tehran, Iran. Tel.: +98-2188003264, Fax: +98-2188945188, E-mail: [email protected].
Shiraz E-Medical Journal. 2009 June; 11(2): 63-72.
Article Type: Research Article; Accepted: May 25, 2009; epub: Jun 17, 2009; ppub: Jun 2009

Abstract


Background and objectives: Lamivudine therapy for chronic hepatitis B (CHB) is associated
with resistance. This study aimed to analyze the response, the incidence of LAM resistance,
and different viral mutational patterns of Lamivudine therapy.
Study design: CHB patients (n=31) who had not previously received interferon or a nucleoside
analogue, received Lamivudine once daily for a minimum of E12 months and followed.
All patients were tested for presence of mutation in YMDD motif of viral polymerase gene at
the end of the first year of treatment, and if indicated in rising alanine aminotransferase
(ALT) or HBVDNA titer. Polymerase chain reaction along with restriction fragment length
polymorphism (PCR-RFLP) method was used to detect mutations in YMDD motif.
Results: The mean age of patients was 45.2 (SD 13.5) years. The mean follow-up period of
patients was 45.5 (21.9) months. Seventeen patients (54.8%) had mutations, and 45.2% of
subjects were sensitive to LAM. Mean time of mutation detection after treatment was 45.5
(SD 25.3) months. The distribution of YMDD status was: 32.3 % YIDD, 3.2% YSDD, 12.9%
YVDD, and 6.5% YVDD/ YIDD. The mean age, pretreatment HBeAg negativity, and high
HBVDNA titer at time of mutation had significant statistical association with occurrence of
YMDD mutants (PV= 0.009, 0.032, 0.049), respectively.
Conclusions: Lamivudine-resistant mutation is common in CHB patients. Regarding different
mutant strains as identified in this study, is necessary for develop more useful treatment
strategies, especially in patients without YMDD mutation and high HBVDNA titer, analysis for
possible new mutants should be performed.

Keywords: Chronic hepatitis B ; Lamivudine; Lamivudine- resistant mutations

Footnotes

Conflicts of interest Commercial or other associations did not pose a conflict of interest to prepare of this review. Also there was not any financial support or grant for this manuscript.