Management of Patients with Chronic Hepatitis B and Antiviral Resistance

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Last updated: July 18, 2013

A 34-year-old Chinese man with chronic hepatitis B infection presents for further evaluation. His laboratory studies show positive hepatitis B e antigen (HBeAg), negative hepatitis B e antibody (anti-HBe), HBV DNA level of 107 IU/ml, and an alanine aminotransferase (ALT) of 80 U/L sustained over 6 months. He begins taking lamivudine (Epivir) 100 mg daily because this is the only medicine covered by his insurance plan at the time. At 3 and 6 months his HBV DNA declines to 105 IU/ml, then 104 IU/ml. Similarly, the ALT declines to 50 U/L and then 40 U/L over the same time. Unfortunately, he is lost to follow-up for 18 months. When he returns to see you, he states that he has been traveling back and forth between China and has faithfully taken lamivudine since his last visit. You repeat lab testing, which demonstrates: HBV DNA 106 IU/ml, ALT 80 U/L, and INR 1.0.

Which one of the following statements is TRUE regarding the management of this patient?

A It is unlikely the patient has developed resistance to lamivudine since HBV resistance to lamivudine rarely occurs in the first 2 to 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.
D Entecavir (Baraclude) 0.5 mg once daily should be added to the lamivudine.