Treatment
Patients who failed to achieve primary response as
evidenced by < 2 log decrease in serum HBV DNA level
after at least 6 months of NA therapy
����Switch to an alternative treatment or receive additional treatment. (III)
Patients who develop breakthrough infection while receiving
NA therapy (Table 5)
����Ascertain compliance and resume treatment in patients who have had
long lapses in medications. (III)
����Perform confirmatory test for antiviral-resistant mutation if possible
to differentiate primary nonresponse from breakthrough infection and
to determine if there is evidence of multi-drug resistance (in patients
who have been exposed to more than one NA treatment). (III)
��Consider all patients with virologic breakthrough for rescue therapy. (II-2)
��
����For patients in whom there was no clear indication for hepatitis B
treatment and who continue to have compensated liver disease,
consider withdrawal of therapy, but closely monitor these patients and
reinitiate treatment if they experience severe hepatitis flares. (III)
Lamivudine (or telbivudine)-resistant HBV
����If adefovir is used, continue lamivudine (or telbivudine) indefinitely to
decrease the risk of hepatitis flares during the transition period and to
reduce the risk of subsequent adefovir resistance. (II-3 for lamivudineresistant HBV and III for telbivudine-resistant HBV)
����If tenofovir is used, continue lamivudine (or telbivudine) to decrease
the risk of subsequent antiviral resistance. (III)
����If entecavir is used, stop lamivudine or telbivudine since continued
presence of lamivudine- (or telbivudine-) resistant mutations will
increase the risk of entecavir resistance. (II-3 for lamivudine-resistant
HBV and III for telbivudine-resistant HBV). Entecavir is not an optimal
therapy because of increasing risk of resistance to entecavir over
time. (II-2)
6
