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resistant hbv mutants are present already in untreated patients
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resistant hbv mutants are present already in untreated patients

large-scale survey of naturally occurring HBV polymerase mu…

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Author: hbv_research-list-owners@mail-list.com
Date: 2011-07-03 23:53 +200
To: hbv_research
Subject: Large-scale survey of naturally occurring HBV polymerase mutations associated with anti-HBV drug resistance in untreated patients with chronic hepatitis B
J Viral Hepat. 2011 Jul;18(7):e212-6. doi: 10.1111/j.1365-2893.2011.01435.x. Epub 2011 Jan 21.



Large-scale survey of naturally occurring HBV polymerase mutations associated with anti-HBV drug resistance in untreated patients with chronic hepatitis B.



Mirandola S, Campagnolo D, Bortoletto G, Franceschini L, Marcolongo M, Alberti A.




Source

Venetian Institute of Molecular Medicine, Padova, Italy Department of Histology, Microbiology and Experimental Medicine, University of Padova, Padova, Italy.




Abstract

Summary.  Drug resistance is a major limitation for the long-term efficacy of antiviral therapy with nucleos(t)ide analogues (NAs) in chronic hepatitis B (CHB). Antiviral resistance mutations may pre-exist in the overall viral population of untreated patients. We aimed to assess the prevalence of such hepatitis B virus (HBV) variants in a large cohort of NAs-naïve patients with CHB and to explore possible association with viral and host variables. Serum samples from 286 NAs-naïve consecutive patients with CHB were tested for serum HBV-DNA, and 255 of them having HBV-DNA > 1000 IU/mL were further analysed for drug resistance mutations by INNO-LiPA HBV DRv2/v3. NAs-naïve patients analysed were mainly men (73%), Caucasians (85%), hepatitis B e Antigen (HBeAg) negative (79%) and genotype D (69%), with a mean age of 43.2 ± 13.4 years. HBV mutations associated with antiviral drug resistance were detected in 13 (5%) patients: three patients infected with HBV genotype C had the rtM204V + rtL180M mutations associated with lamivudine (LMV) resistance. Four patients had the rtI233V mutation that may reduce sensitivity to adefovir, and three patients had the rtM250L/V mutation typical of entecavir resistance. LMV compensatory mutations rtL80V and rtV173L were seen in two and one patients, respectively. No relationship was seen between presence of resistant or compensatory mutations and HBV-DNA levels, HBeAg/anti-HBe status or previous IFN therapy. These results confirm that HBV mutations, which confer resistance against currently available anti-HBV NAs, may already exist in patients who have never received the drug.
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Does this mean it could be an advantage to start treatment early?  
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no it means resistance tests must be done always before starting antivirals because you may already have the resistant mutations

hbv makes thousands of mutants per day according to the dna level and among all the mutants also the drug mutants may be present and develop
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