@article {10860,
	title = {Combined Analysis of the Prevalence of Drug-Resistant Hepatitis B Virus in Antiviral Therapy-Experienced Patients in Europe (CAPRE).},
	journal = {J Infect Dis},
	volume = {213},
	year = {2016},
	month = {2016 Jan 01},
	pages = {39-48},
	abstract = {BACKGROUND: European guidelines recommend treatment of chronic hepatitis B virus infection (CHB) with the nucleos(t)ide analogs (NAs) entecavir or tenofovir. However, many European CHB patients have been exposed to other NAs, which are associated with therapy failure and resistance. The CAPRE study was performed to gain insight in prevalence and characteristics of NA resistance in Europe.

METHODS: A survey was performed on genotypic resistance testing results acquired during routine monitoring of CHB patients with detectable serum hepatitis B virus DNA in European tertiary referral centers.

RESULTS: Data from 1568 patients were included. The majority (73.8\%) were exposed to lamivudine monotherapy. Drug-resistant strains were detected in 52.7\%. The most frequently encountered primary mutation was M204V/I (48.7\%), followed by A181T/V (3.8\%) and N236T (2.6\%). In patients exposed to entecavir (n = 102), full resistance was present in 35.3\%. Independent risk factors for resistance were age, viral load, and lamivudine exposure (P < .001).

CONCLUSIONS: These findings support resistance testing in cases of apparent NA therapy failure. This survey highlights the impact of exposure to lamivudine and adefovir on development of drug resistance and cross-resistance. Continued use of these NAs needs to be reconsidered at a pan-European level.},
	keywords = {Adult, Antiviral Agents, Cross-Sectional Studies, Drug Resistance, Viral, Female, Genotype, Hepatitis B virus, Hepatitis B, Chronic, Humans, Male, Middle Aged, Prevalence},
	issn = {1537-6613},
	doi = {10.1093/infdis/jiv363},
	author = {Hermans, Lucas Etienne and Svicher, Valentina and Pas, Suzan Diepstraten and Salpini, Romina and Alvarez, Marta and Ben Ari, Ziv and Boland, Greet and Bruzzone, Bianca and Coppola, Nicola and Seguin-Devaux, Carole and Dyda, Tomasz and Garcia, Federico and Kaiser, Rolf and K{\"o}se, Sukran and Krarup, Henrik and Lazarevic, Ivana and Lunar, Maja M and Maylin, Sarah and Micheli, Valeria and Mor, Orna and Paraschiv, Simona and Paraskevis, Dimitrios and Poljak, Mario and Puchhammer-St{\"o}ckl, Elisabeth and Simon, Fran{\c c}ois and Stanojevic, Maja and Stene-Johansen, Kathrine and Tihic, Nijaz and Trimoulet, Pascale and Verheyen, Jens and Vince, Adriana and Weis, Nina and Yalcinkaya, T{\"u}lay and Zidovec Lepej, Snjezana and Perno, Carlo and Boucher, Charles A B and Wensing, Annemarie M J}
}
