Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11641
Revised: January 10, 2014
Accepted: May 28, 2014
Published online: September 7, 2014
Processing time: 320 Days and 22 Hours
Rescue antiviral treatment for patients with resistance to preexisting nucleos(t)ide analogues remains a clinical challenge. The correct choice of a first-line treatment of high potency and with a high genetic barrier to achieve sustained long-term suppression of viral replication provides the best chance of preventing treatment failure and the emergence of drug resistance. The management of treatment failure and drug resistance requires a precise and accurate clinical and virologic monitoring. Combination treatment with antiviral drugs that belong to different groups is associated with a lower chance of developing resistance to rescue drugs. To guarantee better control of viral replication in patients with drug resistance, the addition of another drug without a cross resistance profile should be given as early as possible, preferably at the time when genotypic resistance emerges. Long-term surveillance for treatment efficacy and possible emergence of drug resistance should be continued to prevent the emergence of multidrug-resistant strains.
Core tip: Proliferation of hepatitis B virus (HBV) is the key driver of liver injury and disease progression, and thus sustained HBV suppression is of paramount importance in the management of chronic hepatitis B. Long-term antiviral treatment is usually required to achieve sustained suppression of HBV. However, antiviral drug resistance is a serious problem of long-term antiviral treatment, and this poses a critical challenge. Prevention and proper management of antiviral drug resistance are decisive to long-term success of treatment.