Sayan Murat
Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
Hepat Mon. 2010 Winter;10(1):42-7. Epub 2010 Mar 1.
Entecavir (ETV) is a potent nucleoside analogue against hepatitis B virus (HBV). Because of development of ETV resistance requires at least three amino acid substitutions in HBV polymerase (pol) gene, emergence of ETV resistance is rare (~1%) in nucleoside-naive patients after up to 5 years of treatment. However, it has been suggested that lamivudine (LAM) therapy can preselect for HBV variants associated with resistance to ETV treatment. ETV resistance increased to 51% of patients after 5 years of ETV treatment in LAM refractory patients. The diagnosis of ETV resistance in chronic hepatitis B patients, mainly based on four types of molecular assays: direct sequencing, line probe assay, clonal analysis,and restriction fragment length polymorphism (RFLP) analysis. The applications of other assays are currently more specialized,and their use is more limited. The utility of these assays and their performance characteristics are reviewed below.Briefly, the monitoring of drug-resistant variants is important in the elucidation of the prevalence and mechanisms of resistance development and for the more effective management of treatment options.
恩替卡韦(ETV)是一种强效的抗乙型肝炎病毒(HBV)核苷类似物。由于恩替卡韦耐药的发生需要乙型肝炎病毒聚合酶(pol)基因至少发生三个氨基酸替换,因此在初治核苷类药物患者中,接受长达5年的治疗后,恩替卡韦耐药的发生率很低(约1%)。然而,有研究表明,拉米夫定(LAM)治疗可预先选择出与恩替卡韦治疗耐药相关的HBV变异株。在拉米夫定难治性患者中,接受恩替卡韦治疗5年后,恩替卡韦耐药率增至51%。慢性乙型肝炎患者中恩替卡韦耐药的诊断主要基于四种分子检测方法:直接测序、线性探针分析、克隆分析和限制性片段长度多态性(RFLP)分析。目前,其他检测方法的应用更为专业,其用途也更为有限。以下将对这些检测方法的效用及其性能特点进行综述。简而言之,监测耐药变异株对于阐明耐药发生率及耐药发生机制以及更有效地管理治疗方案具有重要意义。