Table 1.
Resistant drug | AASLD 2009[18] | EASL 2012[16] | APASL 2012[17] | KASL 2012[13] |
LMV | Add ADV or TDF Stop LMV, switch to Truvada (TDF + FTC) | Switch to TDF Add ADV (If TDF not available) | Add ADV Switch to TDF Switch to IFN-based therapy | Add ADV or TDF Stop LMV, switch to ADV or TDF + other nucleoside analogues Switch to TDF Stop LMV, consider to switch with Peg IFN |
ADV | Add LMV Stop ADV, switch to Truvada Stop ADV, switch to or add ETV | NA-naïve; Switch to ETV or TDF Prior LMV-resistance; Switch to TDF + a nucleoside analogue | Add LMV, LdT, or ETV Switch to TDF Switch to IFN-based therapy | With prior LMV resistance, -Stop ADV, switch to TDF + other nucleoside analogues -Add ETV 1mg ADV as a first-line therapy -Stop ADV, switch to TDF + other nucleoside analogues -Add other nucleoside analogue, if rtA181T, add ETV |
ETV | Switch to TDF or Truvada | Switch to TDF Add TDF Add ADV (If TDF not available) | Add TDF or ADV Switch to IFN-based therapy | Add nucleotide analogue |
LdT | Same treatment as LMV | Switch to TDF Add TDF Add ADV (If TDF not available) | Same treatment as LMV | Same treatment as LMV |
CLV | Same treatment as LMV | |||
TDF | Add ETV, LdT, LMV or FTC (LMV-naïve; Switch to ETV/ prior LMV-resistance; Add ETV) | |||
Multidrug-resistance | Combination of a nucleoside and a nucleotide (preferably TDF) | ETV + TDF Switch to IFN-based therapy | TDF + ETV 1 mg ADV + ETV 1 mg | |
Comment | Update is required especially for multidrug-resistance | Recommendation about IFN-based therapy is limited | Recommendation about TDF resistance is limited | Recommendation about TDF resistance and IFN-based therapy is limited |
KASL: Korean Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases; APASL: Asian Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; LMV: Lamivudine; ADV: Adefovir; LdT: Telbivudine; CLV: Clevudine; TDF: Tenofovir; FTC: Emtricitabine; ETV: Entecavir; IFN: Interferon.