title: Use of nucleoside analogs in patients with chronic hepatitis B in Nepal: A prospective cohort study in a single hospital.
abstract: OBJECTIVE
  There still remain many concerns about the present status of antiviral therapy for chronic hepatitis B in developing countries in Asia, where the monitoring systems of virological markers have not been well established, despite the high prevalence of hepatitis B virus (HBV) infection. To investigate it in Nepal, this prospective cohort study was conducted at the Teaching Hospital of Tribhuvan University in Kathmandu.
  
  
  METHODS
  From 2007 to 2012, 65 patients were consecutively enrolled, 44 of whom received nucleoside analogs (NA), such as lamivudine (LMV), adefovir or tenofovir (TDF), on the decision of the local hepatologist. Virological determinations were performed in Japan, by using the serially collected serum samples at the Teaching Hospital. Statistical analysis was performed, using Mann-Whitney U-test or Fisher's exact test.
  
  
  RESULTS
  The younger, especially female patients of reproductive age were more frequently prescribed with these NA, and an increased preference for the use of TDF was observed over time. However, there was insufficient follow up of the NA-treated patients in this cohort, and not a few patients developed emergence of NA-resistant HBV: known resistance to LMV in 3 patients and incidental resistance to non-administrated NA in four patients.
  
  
  CONCLUSIONS
  The results of the present study indicate that education for physicians as well as for infected patients regarding the proper use of NA, together with establishment of appropriate monitoring systems for virological markers, is warranted to prevent an increase in NA-resistant HBV infections in Nepal.
authors.affiliation: The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Masaki
authors.affiliation: Department of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Pradeep Krishna
authors.initials: PK
authors.lastname: Shrestha
authors.affiliation: Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Nishimura
authors.affiliation: The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Ito
authors.affiliation: The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
keywords: antiviral therapy; chronic hepatitis B; hepatitis B virus; nucleoside analogs; resistance