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Antiviral Drug Resistance Testing in Patients with Chronic Hepatitis B

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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.

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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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Conflicts of interest

Vincent WS Wong is a member of the advisory boards of Novartis Pharmaceutical, Roche Pharmaceuticals and Gilead, and received a paid lecture fee from Abbott Diagnostics. Stephen Locarnini is a board member of Evivar Medical Pty Ltd. Henry LY Chan is a member of the advisory boards of Novartis Pharmaceutical, Schering-Plough Corporation, Bristol-Myers Squibb, Pharmasset, Roche Pharmaceutical, Roche Diagnostics and Abbott Diagnostics.

Author information

Authors and Affiliations

  1. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, Hong Kong

    Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Chi-Hang Tse, Hoi-Yun Chan & Henry Lik-Yuen Chan

  2. Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong

    Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Chi-Hang Tse, Hoi-Yun Chan & Henry Lik-Yuen Chan

  3. Victorian Infectious Disease Research Laboratory, Melbourne, Australia

    Lilly K. W. Yuen & Stephen A. Locarnini

Authors
  1. Vincent Wai-Sun Wong
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  2. Grace Lai-Hung Wong
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  3. Chi-Hang Tse
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  4. Lilly K. W. Yuen
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  5. Hoi-Yun Chan
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  6. Stephen A. Locarnini
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  7. Henry Lik-Yuen Chan
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Corresponding author

Correspondence to Henry Lik-Yuen Chan.

Appendix

Appendix

See Table 5.

Table 5 Case scenarios in the questionnaire survey
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Wong, V.WS., Wong, G.LH., Tse, CH. et al. Antiviral Drug Resistance Testing in Patients with Chronic Hepatitis B. Dig Dis Sci 57, 221–231 (2012). https://doi.org/10.1007/s10620-011-1816-6

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  • DOI: https://doi.org/10.1007/s10620-011-1816-6

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