First Report of Entecavir and Tenofovir Resistance in Iraq for Chronic Hepatitis B Patients

Abstract

The primary goal of therapy for chronic hepatitis B (CHB) is to prevent liver disease progression. In patients with drug-resistant hepatitis B virus (HBV), a combination of tenofovir disoproxil fumarate (TDF) and entecavir (ETV), which is strongest combination therapy against HBV. However, long-term tolerance data are lacking, and cost may be an issue for combination therapies. Several, well-designed, randomized controlled trials have shown that TDF monotherapy provides similar antiviral efficacy compared with the combination of TDF and ETV. Mutations in the polymerase (Pol) gene of hepatitis B virus (HBV) are often associated with drug resistance. The pattern of mutations varies geographically, thus giving rise to infection to HBV diversity.

 This study was carried out to detect mutations in Pol gene of hepatitis B virus isolated from CHB Iraqi patients. Selected 20 CHB patients who's had highly viral load after treatment course (6 months) were analyzed by PCR and sequencing, also S202GCI mutation was most frequently detected 9/20 (45%) and followed by M204V/I/S (40%), L180M (35%), M250V/I/L and  A181T/V (30%), T184SCGA, N236T and A194T (25%), T184ILFM (10%). T184SCGA, T184ILFM, S202GCI and M250V/I/L mutations association with  Entecavir resistance,  A194T mutation association with Tenofovir resistance and  L180M, A181T/V, M204V/I/S and N236T mutations association with multi –drug resistance.