Review
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World J Gastroenterol. Dec 28, 2012; 18(48): 7149-7157
Published online Dec 28, 2012. doi: 10.3748/wjg.v18.i48.7149
Diagnostic and therapeutic progress of multi-drug resistance with anti-HBV nucleos(t)ide analogues
Zhuo-Lun Song, Yu-Jun Cui, Wei-Ping Zheng, Da-Hong Teng, Hong Zheng
Zhuo-Lun Song, Organ Transplant Center, The First Center Clinical College, Tianjin Medical University, Tianjin 300192, China
Yu-Jun Cui, Wei-Ping Zheng, Da-Hong Teng, Hong Zheng, Organ Transplant Center, Tianjin First Center Hospital, Tianjin 300192, China
Author contributions: Zheng H conducted the review; Song ZL wrote the paper; Cui YJ, Zheng WP and Teng DH revised the review.
Correspondence to: Hong Zheng, PhD, MD, Professor, Organ Transplant Center, Tianjin First Center Hospital, 24 Fukang Road, Nankai District, Tianjin 300192, China. zhenghongxy@163.com
Telephone: +86-22-23626112 Fax: +86-22-23626112
Received: July 31, 2012
Revised: November 2, 2012
Accepted: November 6, 2012
Published online: December 28, 2012
Processing time: 183 Days and 20.5 Hours
Abstract

Nucleos(t)ide analogues (NA) are a breakthrough in the treatment and management of chronic hepatitis B. NA could suppress the replication of hepatitis B virus (HBV) and control the progression of the disease. However, drug resistance caused by their long-term use becomes a practical problem, which influences the long-term outcomes in patients. Liver transplantation is the only choice for patients with HBV-related end-stage liver disease. But, the recurrence of HBV after transplantation often caused by the development of drug resistance leads to unfavorable outcomes for the recipients. Recently, the multi-drug resistance (MDR) has become a common issue raised due to the development and clinical application of a variety of NA. This may complicate the antiviral therapy and bring poorly prognostic outcomes. Although clinical evidence has suggested that combination therapy with different NA could effectively reduce the viral load in patients with MDR, the advent of new antiviral agents with high potency and high genetic barrier to resistance brings hope to antiviral therapy. The future of HBV researches relies on how to prevent the MDR occurrence and develop reasonable and effective treatment strategies. This review focuses on the diagnostic and therapeutic progress in MDR caused by the anti-HBV NA and describes some new research progress in this field.

Keywords: Hepatitis B virus; Multi-drug resistance; Nucleos(t)ide analogues; Gene mutation; Liver transplantation