The emergence of nucleoside antiviral drugs in the antiviral treatment of hepatitis B is undoubtedly a great achievement, which has benefited hepatitis B patients greatly. However, with the prolonged use of this class of drugs, the problem of virus resistance to this class of drugs has gradually begun to be exposed, and how to break through this bottleneck has become a difficult problem in the treatment of chronic hepatitis B patients.
In this regard, experts will discuss their views and suggestions on the prevention, monitoring and treatment of hepatitis B virus drug resistance.
First of all, how to prevent the occurrence of drug resistance in antiviral therapy, academician Zhuang believes that it should be addressed from seven points.
(1) Avoid unnecessary treatment.
(2) Apply drugs with high resistance gene barrier and strong antiviral ability.
(3) Switch to other antiviral drugs for those with unsatisfactory early response.
(4) Avoid monotherapy sequential therapy and use combination therapy if possible.
(5) standardize treatment (standardized regimen and dose, and treatment according to a route map, etc.)
(6) Improving patient compliance with treatment.
(7) Strengthening drug resistance monitoring (including pre-treatment monitoring).
Second, for the monitoring of drug resistance in antiviral therapy, Academician Zhuang believes that four indications should be identified.
(1) elevated viral load (≥1.0log10U/ml).
(2) elevated serum ALT levels.
(3) clinical exacerbation of the disease.
(4) Detectable resistance gene variants in the viral polymerase region.
Third, rescue of drug resistance in antiviral therapy to lamivudine
Addition of adefovir.
Switching to entecavir.
Switching to Truvada (a combination of emtricitabine and tenofovir).
Addition of tenofovir. Resistant to adefovir
Addition of lamivudine.
Addition of transticavir.
Switching to entecavir.
Switch to Truvada. resistant to entecavir
Addition of adefovir.
Switch to adefovir.
Addition of tenofovir.
Switch to tenofovir.