Abstract
Hepatitis B virus (HBV) infection is contagious with transmissiobn vertically or horizontally by blood products and body secretions. Over 50% of Iranian carriers contracted the infection prenatally, making this the most likely route of transmission of HBV in Iran. To evaluate the resistance to adefovir (ADV) therapy in patients with chronic hepatitis B infection, a study was conducted on 70 patients (63 males and 7 females), who had received in first line lamivudine and second line adefovir. All were tested for the presence of hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), serum alanine amino transferase (ALT) level and HBV DNA load before and after treatment with ADV. In all samples, resistance to lamivudine and ADV was tested with real time PCR. Among seventy patients with chronic hepatitis B infection, 18 (25.7%) were resistant to LAM and 8 (11.4%) were resistant to ADV. Only one patient was negative for the presence of HBS-Ag (5.6%) and two were negative for HBe-Ag (11.1%). In this study we used a new method (ALLGIO probe assay) that has high sensitivity in detection of adefovir resistance mutants, which we recommend to other researchers. Mutant strains of the YMDD motif of HBV polymerase can be found in some patients under treatment with lamivudine and ADV. ADV has been demonstrated to be efficient in patients with lamivudine resistant HBV.
Highlights
Hepatitis B virus (HBV) infections are a major cause of acute and chronic hepatitis, and of its long-term complications for example decompensate cirrhosis and hepatocellular carcinoma (HCC) (Hosaka et al, 2010)
Patient selection In retrospective study, seventy patients (63 males and 7 females, mean age 44 years, range 41-66 years) who were diagnosed as Chronic Hepatitis B infection from October 2010 to December 2011 in our laboratory (Virology Laboratory of the Besat Specialist Clinic, Kerman, IRAN) following the guidelines of prevention and treatment of chronic hepatitis B were enrolled in this study
In chronic Hepatitis B infection, patients not able to clear the virus as judged by a positive hepatitis B surface antigen (HBsAg) for six months after the acute episode and are known as chronic cases
Summary
Hepatitis B virus (HBV) infections are a major cause of acute and chronic hepatitis, and of its long-term complications for example decompensate cirrhosis and hepatocellular carcinoma (HCC) (Hosaka et al, 2010). ADV has become the treatment option for HBV infection due to its effect on lamivudine-resistant mutations occurring upon prolonged treatment. Sequencing remains the best approach to the identification of new mutations It cannot detect rtN236T and rtA181V/T mutations in less than 25% of a total viral population and is not appropriate for large-scale use in large cohort studies or clinical laboratories because of its labor intensive and time consuming manipulations (Liu et al, 2010). PCR-RFLP could only detect mutations in a high proportion and is labor intensive and time consuming
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