Molecular diagnosis and treatment of drug-resistant hepatitis B virus

Table 1 Guidelines for treatment of resistance

Resistant drug	AASLD 2009[18]	EASL 2012[16]	APASL 2012[17]	KASL 2012[13]
LMV	Add ADV or TDF Stop LMV, switch to Truvada (TDF + FTC)	Switch to TDF Add ADV (If TDF not available)	Add ADV Switch to TDF Switch to IFN-based therapy	Add ADV or TDF Stop LMV, switch to ADV or TDF + other nucleoside analogues Switch to TDF Stop LMV, consider to switch with Peg IFN
ADV	Add LMV Stop ADV, switch to Truvada Stop ADV, switch to or add ETV	NA-naïve; Switch to ETV or TDF Prior LMV-resistance; Switch to TDF + a nucleoside analogue	Add LMV, LdT, or ETV Switch to TDF Switch to IFN-based therapy	With prior LMV resistance, -Stop ADV, switch to TDF + other nucleoside analogues -Add ETV 1mg ADV as a first-line therapy -Stop ADV, switch to TDF + other nucleoside analogues -Add other nucleoside analogue, if rtA181T, add ETV
ETV	Switch to TDF or Truvada	Switch to TDF Add TDF Add ADV (If TDF not available)	Add TDF or ADV Switch to IFN-based therapy	Add nucleotide analogue
LdT	Same treatment as LMV	Switch to TDF Add TDF Add ADV (If TDF not available)	Same treatment as LMV	Same treatment as LMV
CLV				Same treatment as LMV
TDF		Add ETV, LdT, LMV or FTC (LMV-naïve; Switch to ETV/ prior LMV-resistance; Add ETV)
Multidrug-resistance		Combination of a nucleoside and a nucleotide (preferably TDF)	ETV + TDF Switch to IFN-based therapy	TDF + ETV 1 mg ADV + ETV 1 mg
Comment	Update is required especially for multidrug-resistance	Recommendation about IFN-based therapy is limited	Recommendation about TDF resistance is limited	Recommendation about TDF resistance and IFN-based therapy is limited

KASL: Korean Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases; APASL: Asian Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; LMV: Lamivudine; ADV: Adefovir; LdT: Telbivudine; CLV: Clevudine; TDF: Tenofovir; FTC: Emtricitabine; ETV: Entecavir; IFN: Interferon.