What are the AASLD guidelines for patients with poor response to antiviral treatment for hepatitis B (HBV) (Hep B)?

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

For patients with persistent low-level viremia (< 2,000 IU/mL) (plateau in the decline of HBV DNA and/or failure to achieve undetectable HBV DNA level after 96 weeks of therapy) on entecavir or tenofovir monotherapy, the AASLD suggests continuing monotherapy, regardless of ALT the level.

For patients with virologic breakthrough on entecavir or tenofovir monotherapy (an increase in HBV DNA by >1 log compared to nadir or HBV DNA ≥100 IU/mL in those on NA therapy with previously undetectable levels [< 10 IU/mL]), either (1) switch to another antiviral monotherapy with a high barrier to resistance or (2) add a second antiviral drug that lacks cross-resistance.

To detect persistent viremia and virologic breakthrough, the AASLD suggests monitoring HBV DNA levels every 3 months until they are undetectable, followed by every 3-6 months thereafter. In addition, if NA therapy with a drug other than entecavir or tenofovir is used and virologic breakthrough occurs, switch to another antiviral monotherapy with a high genetic barrier to resistance or add a second antiviral with a complementary resistance profile.


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