Management of antiviral drug resistance in chronic hepatitis B

Table 2 Recommendations of guidelines for rescue therapy in chronic hepatitis B patients with antiviral drug resistance

Drugs to which antiviral resistance developed	AASLD (2009)[74]	EASL (2012)[6]	APASL (2008)[75]
LAM	Add ADV or TDF	Switch to TDF	Add-on ADV therapy
	Stop LAM, switch to Truvada®1	Add ADV, if TDF is not available	Switching to ETV therapy (1 mg/d) is an option
			Switching to interferon-based therapy is an option
LdT	Add ADV or TDF	Switch to TDF	Add-on ADV therapy
	Stop LdT, switch to Truvada®	Add ADV, if TDF is not available.	Switching to interferon-based therapy is an option
ADV	Add LAM2	If nucleoside-naive before ADV then switch to ETV or TDF	For LAM-naive patients who develop drug resistance while on ADV, add-on or switching to LAM, LdT, or ETV is indicated
	Stop ADV, switch to Truvada®	If the patient has high viremia then switch to ETV	Switching to interferon-based therapy is an option
	Switch to or add ETV2	If there is prior LAM resistance then switch to TDF or add a nucleoside analogue
ETV	Switch to TDF or Truvada®	Switch to or add TDF Add ADV, if TDF is not available

¹Truvada^® = combination pill with emtricitabine 200 mg and TDF 300 mg;

²Durability of viral suppression unknown, especially in patients with prior LAM resistance. AASLD: American Association for the Study of the Liver Diseases; EASL: European Association for the Study of the Liver Diseases; APASL: Asian-Pacific Assocation for the study of the Liver Diseases; LAM: Lamivudine; LdT: Telbivudine; ETV: Entecavir; ADV: Adefovir; TDF: Tenofovir.