Management of Patients with Chronic Hepatitis B and Antiviral Resistance

You answered:

A It is unlikely the patient has developed resistance to lamivudine since HBV resistance to lamivudine rarely occurs in the first 2-3 years of lamivudine therapy.

This answer is incorrect. With lamivudine monotherapy, resistance frequently develops. As many as 17-32% of patients develop the M204V/I mutation (in the tyrosine-methionine-aspartate-aspartate [YMDD] motif) after one year of therapy and nearly 70% of patients develop resistance after 4 years of lamivudine therapy. Thus, for this patient who is taking lamivudine and has a HBV DNA level of 106 IU/ml it is very likely this patient has developed resistance to lamivudine.

Choose another answer:

B The patient would likely have a good response with the addition of adefovir (Hepsera) 10 mg once daily or tenofovir (Viread) 300 mg once daily.
C Adding telbivudine (Tyzeka) 600 mg once daily would be the preferred management strategy.
D Entecavir (Baraclude) 0.5 mg once daily should be added to the lamivudine.

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