Current Hepatology Reports

, Volume 18, Issue 3, pp 363–369 | Cite as

Management of Virologic Failure in Patients with Chronic Hepatitis B Treated with Nucleos(t)ide Analogues

  • Zaid H. TafeshEmail author
  • Robert S. BrownJr
Hepatitis B (JK Lim, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hepatitis B


Purpose of the Review

Poorly controlled hepatitis B increases the risk for liver-related morbidity. Although there are now six approved nucleos(t)ide analogues (NA) for the treatment of chronic hepatitis B (CHB), drug resistance and thus virologic breakthrough still exist. This review outlines a systematic approach to the management of virologic failure in patients with CHB treated with NAs.

Recent Findings

Current NAs can be divided into older generation and newer generation agents, with newer generation agents associated with lower rates of virologic breakthrough. Both tenofovir dipovoxil fumarate (TDF) and tenofovir alafenamide (TAF) are equally as effective in addressing virologic breakthrough while on all other NAs. Entecavir is an effective treatment option for NA naïve patients only, with high rates of resistance to entecavir in those exposed to older NAs.


The management of virologic breakthroughs should focus on identifying risk factors for future drug resistance and escalation to appropriate newer generation drug options to avoid long-term liver-related morbidity.


Chronic hepatitis B Nucleos(t)ide analogues Virologic breakthrough Hepatitis B viremia Cirrhosis Viral hepatitis 


Compliance with Ethical Standards

Conflict of Interest

Dr. Brown reports grants and personal fees from Gilead, personal fees from BMS, outside the submitted work. Dr. Tafesh declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology & HepatologyWeill Cornell MedicineNew YorkUSA

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