title: Lamivudine resistance in untreated chronic hepatitis B patients in Turkey.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical Bacteriology and Infectious Diseases, Ufuk University, Medical School, Ankara, Turkey. semrakuli@yahoo.com
authors.forename: Semra
authors.initials: S
authors.lastname: Tunçbilek
authors.forename: Sükran
authors.initials: S
authors.lastname: Köse
authors.forename: Ahmet
authors.initials: A
authors.lastname: Elaldi
authors.forename: Sezin
authors.initials: S
authors.lastname: Akman
mesh_terms: D000293:Adolescent; D000328:Adult; D020816:Amino Acid Motifs / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis / Q000706:statistics & numerical data; D004279:DNA, Viral / Q000235:genetics; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014421:Turkey; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine