Gut Liver.  2017 Mar;11(2):189-195. 10.5009/gnl15562.

Management of Antiviral Resistance in Chronic Hepatitis B

• Lim YS

• KMID: 2412184
• DOI: http://doi.org/10.5009/gnl15562

Abstract

The primary goal of therapy for chronic hepatitis B (CHB) is to prevent liver disease progression. Hepatitis B surface antigen (HBsAg) seroclearance or seroconversion is regarded as an optimal endpoint to discontinue treatment. However, HBsAg seroclearance occurs very rarely with nucleos(t)ide analog (NUC) treatment, and long-term, almost indefinite, NUC treatment is required for the majority of patients. In patients with drug-resistant hepatitis B virus (HBV), a combination of tenofovir disoproxil fumarate (TDF) and entecavir (ETV), which is currently regarded as the strongest combination therapy against HBV, would be potentially safe to prevent the emergence of additional HBV resistance mutations. However, long-term tolerance data are lacking, and cost may be an issue for combination therapies. Several recent, well-designed, randomized controlled trials have shown that TDF mono-therapy provides similar antiviral efficacy compared with the combination of TDF and ETV. Furthermore, no additional HBV resistance mutations emerged during TDF monotherapy for up to 96 weeks. Considering a comparable antiviral efficacy, extremely low risk of TDF-resistance, lower cost, and better safety potential, TDF monotherapy would be a reasonable choice for the treatment of drug-resistant patients with CHB.

Keyword

Adefovir; Entecavir; Lamivudine; Monotherapy; Tenofovir

MeSH Terms

Adenine/analogs & derivatives/therapeutic use
Antiviral Agents/*therapeutic use
Drug Resistance, Multiple, Viral/*physiology
Drug Therapy, Combination
Guanine/analogs & derivatives/therapeutic use
Hepatitis B Surface Antigens/blood
Hepatitis B virus/*drug effects/genetics
Hepatitis B, Chronic/blood/*drug therapy
Humans
Lamivudine/therapeutic use
Organophosphonates/therapeutic use
Tenofovir/therapeutic use
Antiviral Agents
Hepatitis B Surface Antigens
Organophosphonates
Lamivudine
Guanine
Tenofovir
Adenine