Management of Patients with Chronic Hepatitis B and Antiviral Resistance

You answered:

D Entecavir (Baraclude) 0.5 mg once daily should be added to the lamivudine.

This answer is incorrect. Although entecavir is more potent than lamivudine (and has a higher barrier to resistance), it has reduced efficacy in patients with pre-existing lamivudine resistance because of partial cross-resistance. Most experts would not view a switch to entecavir as the best option in this setting. In addition, if entecavir is used in patients who have lamivudine resistance, it should be used at the 1.0 mg once daily dose, which is twice the dose given to patients without lamivudine resistance.

Choose another answer:

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.
B The patient would likely have a good response with a switch to tenofovir (Viread) 300 mg once daily.
C Adding telbivudine (Tyzeka) 600 mg once daily would be the preferred management strategy.

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