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WHO GET LAMIVUDINE RESISTANCE AND HOW CAN WE OPTIMIZE THE TREATMENT IN PATIENTS WITH CHRONIC VIRAL HEPATITIS B INFECTION
I Al Qarshoubi, EJ Heathcote
University Of Toronto
Lamivudine is the only licensed nucleoside analogue for the treatment of chronic hepatitis B in Canada. Lamivudine resistance is common particularly with increasing duration of therapy.
Aim: To evaluate risk factors associated with lamivudine resistance in Canadian patients with chronic hepatitis B infection treated with lamivudine for more then one year.
Methods: An REB approved retrospective chart review of baseline and demographic features including age, body mass index (BMI), race, ALT, HBe status, prior interferon treatment, and score for activity, fibrosis and fat on pretreatment liver biopsy, was conducted. Compliance with lamivudine as well as baseline and serial HBV DNA (iu/ml) were also tabulated. Lamivudine resistance was defined as a sustained rise 1log HBV DNA above the nadir and/or confirmed genetic testing. Statistical analysis was carried out by a series of univariate and multivariate logistic regression analysis.
Results: There were 144 patients who received lamivudine out of which 114 (79.2%) were male, 60 (41.7%) were HBeAg pos and 44 (30.6%) were Caucasian. The risk factors independently associated with lamivudine resistance were high BMI and high baseline HBV DNA.
Conclusion: Our study indicates one of the two risk factors, which increase the risk for lamivudine resistance is potentially preventable (obesity).