tailieunhanh - Báo cáo y học: "Novel mutation in YMDD motif and direct neighbourhood in a child with chronic HBV-infection and clinical lamivudine and adefovir resistance - a scholarly case"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Novel mutation in YMDD motif and direct neighbourhood in a child with chronic HBV-infection and clinical lamivudine and adefovir resistance - a scholarly case | Schildgen et al. Virology Journal 2010 7 167 http content 7 1 167 VIROLOGY JOURNAL CASE REPORT Open Access Novel mutation in YMDD motif and direct neighbourhood in a child with chronic HBV-infection and clinical lamivudine and adefovir resistance - a scholarly case Verena Schildgen1 4 Susanne Ziegler2 3 Ramona LTillmann4 and Oliver Schildgen 2 3 Abstract Context Chronic HBV infection is a major cause of hepatocellular carcinoma HCC which meanwhile has become the 5th most reason for a fatal outcome of cancer. Worldwide approximately 350 million people are chronically HBV infected and as such of risk to develop HCC of those an estimated high rate of children. Treatment of chronic infection is sufficient to reduce the rate of HCC but the rate of sustained virological response remains to low not at least due to emergence of resistant virus strains. Less is known on HBV infection in children despite the extremely high rate of chronicity. Objective Design Setting and Patient The case of a nine years old male with a 6 year history of chronic HBV infection of those 5 years with antiviral treatment is described. Interventions and Main Outcome Measure s Before our lab was consulted the patient was unsuccessfully treated with interferon an obscure drug named Hepon which should activate antiviral immune response and Lamivudine the latter most likely becoming ineffective due to the mergence of resistant subpopulations rtL180 M rtV207 M two strains with stop codons at position rt188 and rt198 rtM204V YVDD rtM204K YKDD . Replacement of Lamivudine by adefovir displayed no advantage despite the lack of resistance mutations thus no decrease in viremia was observed under adefovir treatment. Results and Conclusions Novel mutations in the YMDD motif and its direct neighbourhood were observed both being compatible with Lamivudine resistance. No mutations were found that are associated with ADF resistance. Both the clinical course of treatment and the genotypic .