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Article Type

Original Study

Abstract

Objectives The aim of this study was to detect the YMDD mutation responsible for lamivudine resistance in chronic hepatitis B virus (HBV)-infected patients. Background HBV infection is a major global public health problem. The aim of this work was to study the relation between the detection of YMDD mutation and lamivudine resistance in chronic HBV patients. Participants and methods This study included 50 chronic hepatitis B-infected individuals classified into two groups: group I included 25 chronic HBV patients responding to lamivudine (five female and 20 male). Group II included 25 chronic HBV patients resistant to lamivudine (one female and 24 male). All participants were selected from the National Liver Institute, Menofia University. All participants were subjected to full history taking, general examination, clinical examination, abdominal ultrasonography, laboratory investigations including serum alanine aminotransferase and aspartate transaminase, serum bilirubin, serum albumin, and detection of the YMDD mutation by PCR-RFLP. Results Chronic hepatitis B cannot be classified correctly with reliability on the basis of a single assessment. Serial testing for serum enzymes and HBV DNA are almost always helpful. On comparing results of the HBV DNA level and other laboratory investigations among the studied sensitive and resistant groups, it was found that the levels of HBV DNA in the pretreatment, the first, and the post-treatment PCR and the pretreatment and the post-treatment alanine aminotransferase were significantly higher in the resistant group when compared with the sensitive group (P<0.05). In the current study of 20 PCR-RFLP-tested cases, the wild type was detected in 13 cases, and the mutant type was detected in seven cases. The prevalence of mutations in the tested group was thus 35%. Mutation of codon 552 from methionine to valine (rtM204V) and from methionine to isoleucine (rtM204I) was detected in 42.9 and 28.6% of the patients, respectively, and mutation of codon 528 from leucine to methionine (rtL180M) was detected in 28.6% of the patients. Conclusion It could be concluded that antiviral therapy with lamivudine for chronic HBV-infected patients can be effective. However, some patients may experience resistance to lamivudine with the emergence of YMDD mutants, resulting in progressive worsening of liver disease. In this respect, detecting the YMDD mutation during therapy will help to guide antiviral treatment and to establish early stopping rules or add-on strategies to avoid antiviral resistance.

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