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    This document discusses the management of treatment failure in chronic hepatitis B. It notes that the primary goal of antiviral therapy is to prevent liver disease progression, as long-term antiviral therapy is needed in most patients due to viral persistence in hepatocytes. Treatment failure and emergence of drug resistance are major concerns. The best approach is to choose a first-line therapy with a high genetic barrier to resistance, like entecavir or tenofovir, to most effectively suppress viral replication long-term and minimize resistance. Managing treatment failure requires careful clinical and virologic monitoring as well as early intervention with alternative drugs based on their resistance profiles. Ongoing surveillance of treatment efficacy and potential resistance is also important for patients treated sequentially

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    This document discusses the management of treatment failure in chronic hepatitis B. It notes that the primary goal of antiviral therapy is to prevent liver disease progression, as long-term antiviral therapy is needed in most patients due to viral persistence in hepatocytes. Treatment failure and emergence of drug resistance are major concerns. The best approach is to choose a first-line therapy with a high genetic barrier to resistance, like entecavir or tenofovir, to most effectively suppress viral replication long-term and minimize resistance. Managing treatment failure requires careful clinical and virologic monitoring as well as early intervention with alternative drugs based on their resistance profiles. Ongoing surveillance of treatment efficacy and potential resistance is also important for patients treated sequentially

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    15 views2 pages

    Journal of Hepatology

    Uploaded by

    saumyadeep_modak
    This document discusses the management of treatment failure in chronic hepatitis B. It notes that the primary goal of antiviral therapy is to prevent liver disease progression, as long-term antiviral therapy is needed in most patients due to viral persistence in hepatocytes. Treatment failure and emergence of drug resistance are major concerns. The best approach is to choose a first-line therapy with a high genetic barrier to resistance, like entecavir or tenofovir, to most effectively suppress viral replication long-term and minimize resistance. Managing treatment failure requires careful clinical and virologic monitoring as well as early intervention with alternative drugs based on their resistance profiles. Ongoing surveillance of treatment efficacy and potential resistance is also important for patients treated sequentially

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    Journal of Hepatology

    Volume 56, Supplement 1, 2012, Pages S112S122


    Management of Liver Diseases 2012

    Management of treatment failure in chronic hepatitisB


    Fabien Zoulima, b, c, d, Stephen Locarninie
    a

    INSERM, U1052, Cancer Research Center of Lyon, 69003 Lyon, France Universit de Lyon, 69003 Lyon, France Hospices Civils de Lyon, Hepatology Department, 69004 Lyon, France Institut Universitaire de France Victorian Infectious Diseases Reference Laboratory, 10 Wreckyn St, North Melbourne, Victoria, Australia, 3051

    b
    c

    http://dx.doi.org/10.1016/S0168-8278(12)60012-9, How to Cite or Link Using DOI Permissions & Reprints

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    Summary
    Antiviral therapy of chronic hepatitisB remains a clinical challenge. The primary goal of therapy is to prevent liver disease progression. Because of the mechanism of viral persistence in infected hepatocytes, long-term antiviral therapy is needed in the majority of patients. Incomplete viral suppression and emergence of drug resistance is a major concern. The correct choice of a first-line potent therapy to achieve sustained long-term suppression of viral replication provides the best chance of preventing treatment failure and drug resistance. Clinical studies have demonstrated that drugs with a high barrier to resistance, such as entecavir andtenofovir, have significantly lower rates of resistance when compared

    with those with a low barrier to resistance such as lamivudine, adefovir, or telbivudine. Management of treatment failure requires a precise clinical and accurate virologic monitoring as well as an early treatment intervention with appropriate complementary drugs with respect to their cross-resistance profile. Longterm surveillance for treatment efficacy and possible emergence of drug resistance is necessary for those patients who have been sequentially treated with multiple antivirals. Finally, the identification of novel treatment targets remains a major research challenge to improve the efficacy of current antiviral therapy.

    Keywords
    HepatitisB; Antiviral therapy; Drug resistance

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