Management of Antiviral Resistance in Chronic Hepatitis B

• Published in: Gut and liver Vol. 11; no. 2; pp. 189 - 195
• Main Author: Lim, Young-Suk
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 15.03.2017; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: adefovir; Adenine - analogs & derivatives; Adenine - therapeutic use; Antiviral Agents - therapeutic use; Drug Resistance, Multiple, Viral - physiology; Drug Therapy, Combination; entecavir; Guanine - analogs & derivatives; Guanine - therapeutic use; Hepatitis B Surface Antigens - blood; Hepatitis B virus - drug effects; Hepatitis B virus - genetics; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - drug therapy; Humans; lamivudine; Lamivudine - therapeutic use; monotherapy; Organophosphonates - therapeutic use; Review; tenofovir; Tenofovir - therapeutic use; 내과학; Tenofovir; Lamivudine; Adefovir; Monotherapy; Entecavir
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl15562

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 monotherapy 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.