Partial Response to Entecavir and Tenofovir in Naïve Patients with Chronic Hepatitis B: Clinical Relevance and Management Authors
Hepatitis B: Therapeutics (P Martin, Section Editor)
First Online: 14 March 2012 DOI:
10.1007/s11901-012-0127-5 Cite this article as: Lampertico, P., Viganò, M. & Colombo, M. Curr Hepatitis Rep (2012) 11: 90. doi:10.1007/s11901-012-0127-5 Abstract
Entecavir and tenofovir are the currently recommended first line analogues for treatment of naïve patients with chronic hepatitis B. Despite their overall efficacy and high genetic barrier granting for a low risk of resistance, both regimens will fail to completely suppress HBV DNA at week 48 in 10% of HBeAg-negative and 30% of HBeAg-positive patients. A pre-treatment level >8 log
10 IU/mL HBV DNA and poor medication adherence were the most significant predictors of a partial virological response (PVR). While the clinical relevance of PVR is still poorly understood, nucleos(t)ide (NUC)-naive PVR patients who maintained detectable levels of viremia in follow up, were at risk of developing resistance to ETV. Patients with a suboptimal decline of viremia during the first 48 weeks of therapy with ETV and/or a residual viremia >1,000 IU/mL, can be protected by a rescue switch to TDF. Resistance to TDF has not been described so far, yet the long-term risk of PVR in TDF-treated patients remains unclear. Keywords HBV infection Chronic hepatitis Antiviral treatment Entecavir Tenofovir Drug resistance Rescue therapy Add-on strategy Long-term treatment Clinical resistance References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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