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3.
Med J Aust ; 195(8): 478, 2011 Oct 17.
Article in English | MEDLINE | ID: mdl-22004402
4.
Med J Aust ; 195(11-12): 711, 2011 Dec 19.
Article in English | MEDLINE | ID: mdl-22171875
5.
J Gastroenterol Hepatol ; 22(7): 1078-85, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17608854

ABSTRACT

BACKGROUND: Lamivudine resistance is associated with long-term monotherapy for chronic hepatitis B and can lead to potentially serious clinical consequences. Scant information exists regarding the influence of hepatitis B virus variants in the development of resistance. The present study was designed to identify factors predictive of lamivudine resistance, with a particular focus on the role of precore and basal core promoter variants in the setting of hepatitis B e antigen-negative disease. METHODS: Eighty-five patients, representing four major genotypes, were followed prospectively on lamivudine therapy. Resistance was defined as an increase in viral load, with polymerase gene sequencing confirming a lamivudine resistance mutation. Median follow up was 19 months (6-54 months). The Cox proportional hazards model was used to determine variables independently predicting for the early onset of lamivudine resistance. RESULTS: The rate of lamivudine resistance was 6%, 31% and 51% at 12, 24 and 48 months, respectively. Multivariate analysis identified the precore variant, high baseline alanine aminotransferase (ALT), and persistent viremia (at 6 months) as independent predictors of the early development of lamivudine resistance, with rate ratios of 4.93 (95% confidence interval [CI]: 1.32-18.5), 1.22 (95%CI: 1.08-1.49), and 4.73 (95%CI: 1.49-15.0), respectively (P < 0.05). Female sex predicted early resistance (rate ratio 5.27 [95%CI: 1.23-22.5, P < 0.05]) although numbers were small (n = 12). Genotype did not influence treatment response nor time to onset of resistance. CONCLUSION: Patients with precore variant hepatitis B virus are likely to develop lamivudine resistance early and should be considered for alternate first-line monotherapy. In the future, combination antiviral therapy may limit the development of resistance.


Subject(s)
Hepatitis C, Chronic/drug therapy , Lamivudine/therapeutic use , Reverse Transcriptase Inhibitors/therapeutic use , Adult , Drug Resistance, Viral , Female , Hepatitis C, Chronic/virology , Humans , Male , Middle Aged , Prospective Studies
6.
Med J Aust ; 181(7): 366-7, 2004 Oct 04.
Article in English | MEDLINE | ID: mdl-15462652

ABSTRACT

Sharps injuries experienced by surgeons are common, but are under-recognised and under-reported. The overall risks of transmission of blood-borne viruses to surgeons are low, with hepatitis C posing the greatest transmission risk. Recent trials show that early treatment of acute hepatitis C results in a cure rate approaching 100%. Surgeons and theatre staff should be encouraged to report and follow up sharps injuries to allow early detection and treatment. Additionally, because exposures to blood-borne viruses may be unrecognised, surgeons should have regular tests for blood-borne viruses. There should be no restriction of practice in the "window period" between potential exposure and obtaining results of testing, because of the overall low risk of transmission.


Subject(s)
Accidents, Occupational/statistics & numerical data , General Surgery , Hepatitis C/epidemiology , Hepatitis C/transmission , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Australia/epidemiology , Blood-Borne Pathogens , Female , Follow-Up Studies , Hepacivirus/isolation & purification , Hepatitis C/prevention & control , Humans , Incidence , Infectious Disease Transmission, Professional-to-Patient/statistics & numerical data , Male , Needlestick Injuries/epidemiology , Primary Prevention/methods , Probability , Risk Assessment
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