Hepatitis B virus Resistance to Antivirals : Diagnosis and Management

Abstract

Antiviral drug-resistance is a major issue during nucleoside/nucleotide analogue long-term therapy that leads to treatment failure and progression to liver disease. The spread of drug-resistant hepatitis B virus (HBV) mutants can be reduced by avoiding unnecessary treatment, choosing potent antiviral drugs with a high barrier to resistance as a first-line therapy, and virological monitoring. In case of virologic breakthrough or partial response to therapy, treatment adherence should be checked and HBV resistance mutations should be identified in order to adapt therapy, as early as possible, with a more potent drug that does not share cross-resistance. However, HBV infection cannot be completely eradicated due to the persistence of cccDNA in infected hepatocytes. New therapeutic strategies and new anti-HBV targets are both needed to promote virologic clearance and subsequently prevent drug-resistance and its complications.