Digestive Diseases and Sciences

, Volume 57, Issue 1, pp 221–231 | Cite as

Antiviral Drug Resistance Testing in Patients with Chronic Hepatitis B

  • Vincent Wai-Sun Wong
  • Grace Lai-Hung Wong
  • Chi-Hang Tse
  • Lilly K. W. Yuen
  • Hoi-Yun Chan
  • Stephen A. Locarnini
  • Henry Lik-Yuen Chan
Original Article

Abstract

Background

Antiviral drugs against hepatitis B virus are limited by the emergence of drug resistance.

Aims

We aimed to study the impact of drug resistance testing on treatment decisions.

Methods

In part 1 of this study, consecutive patients with chronic hepatitis B who had antiviral drug resistance testing were studied. Part 2 was a two-step questionnaire survey including ten characteristic case scenarios. Hepatologists were asked about their treatment decisions before and after the knowledge of drug resistance results.

Results

Fifty-one patients underwent drug resistance testing, most of whom were on lamivudine, adefovir dipivoxil or entecavir monotherapy. Thirty-four (67%) patients had drug-resistant mutants detected, 4 (8%) had low viral load, and 13 (25%) harboured wild-type virus. Twenty-nine of 34 (85%) patients harbouring drug-resistant mutants and 9 of 17 (53%) patients with no mutants detected changed their drug regimens (P = 0.038). In part 2, 18 hepatologists completed all two questionnaires. Overall, treatment decision was modified in 52% of cases upon receiving the drug resistance testing results. The detection of rtA181V/I resulted in decision changes in most hepatologists, with the preferred treatment switching from tenofovir to entecavir. When no mutants were detected in partial responders to entecavir monotherapy, most hepatologists chose to increase the dose of entecavir.

Conclusions

Drug-resistant mutations are detected in around two-thirds of chronic hepatitis B patients undergoing drug resistance testing. Drug resistance testing alters management in over half of the cases, and should be considered in all patients with virological breakthrough and suboptimal virological suppression.

Keywords

Viral load Lamivudine Adefovir dipivoxil Telbivudine Entecavir Tenofovir 

Abbreviations

ADV

Adefovir dipivoxil

ALT

Alanine aminotransferase

Anti-HBe

Antibody against hepatitis B e antigen

ETV

Entecavir

HBeAg

Hepatitis B e antigen

HBsAg

Hepatitis B surface antigen

HBV

Hepatitis B virus

LdT

Telbivudine

LMV

Lamivudine

TDF

Tenofovir

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Vincent Wai-Sun Wong
    • 1
    • 2
  • Grace Lai-Hung Wong
    • 1
    • 2
  • Chi-Hang Tse
    • 1
    • 2
  • Lilly K. W. Yuen
    • 3
  • Hoi-Yun Chan
    • 1
    • 2
  • Stephen A. Locarnini
    • 3
  • Henry Lik-Yuen Chan
    • 1
    • 2
  1. 1.Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong
  2. 2.Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong
  3. 3.Victorian Infectious Disease Research LaboratoryMelbourneAustralia

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