Dergiler / Turkish Journal of Gastroenterology / 2008 / Cilt: 19 - Sayı: 2
Lamivudine resistance in untreated chronic hepatitis B patients in Turkey
- Sayfa
- 99–103
- DOI
- —
Özet
Amaç: Hepatit B virus infeksiyonu tüm dünyada ve Türkiye’de epidemiyolojik bir problemdir. Lamivudin hepatit B virus revers transkriptaz inhibitörlerinden biridir ve kronik hepatit B virus infeksiyonunda kullanılmaktadır. Lamivudin direnci ilaç kullanımından sonra oluşabileceği gibi tedavi almamış hastalarda da görülebilmektedir. Bu direnç polimeraz enzim genindeki tirozin-metionin-aspartat-aspartat motifindeki yapısal değişiklik ile ilişkilidir. Bu çalışmada Türkiye’deki D genotip’li kronik hepatit B’li hastalarda antiviral tedavi öncesi lamivudin direncinin prevalansını belirlemeyi amaçladık. Yöntem: Kronik hepatit B virus infeksiyonlu yetmiş yedi hastanın viral yükleri, HBeAg, antiHBe antikorları ve tirozin-metionin-aspartat- aspartat mutasyonları değerlendirildi. Bulgular: Tirozinmetionin- aspartat-aspartat motif mutasyonu 24 HBeAg pozitif hastanın 3’ünde, 53 antiHBe pozitif hastanın 3’ünde %7.8 oranı nda belirlendi. Mutasyonların ikisi YIDD, dördü YVDD olarak belirlendi. Sonuç: Kronik hepatit B virus hastalarında lamivudin direncinin değerlendirilmesi ve tedaviyi buna göre planlamak komplikasyonları önleyecek ve tedavinin etkinliğini artıracaktır.
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.