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. Author manuscript; available in PMC: 2019 Apr 1.
Published in final edited form as: Hepatology. 2018 Apr;67(4):1560–1599. doi: 10.1002/hep.29800

Table 8.

Antiviral Options for Management of Antiviral Resistance

Antiviral Resistance by Genotypic Testing Switch Strategy (Preferred) Add Strategy: 2 Drugs Without Cross-Resistance
Lamivudine resistance Tenofovir* (TDF or TAF) Continue lamivudine; add tenofovir (TDF or TAF) (or alternative emtricitabine-tenofovir)
Telbivudine resistance Tenofovir* (TDF or TAF) Continue telbivudine; add tenofovir (TDF or TAF)
Adefovir resistance Entecavir or Tenofovir* (TDF or TAF) Continue adefovir; add entecavir
Entecavir resistance Tenofovir* (TDF or TAF) Continue entecavir; add tenofovir (TDF or TAF) or alternative emtricitabine-tenofovir
Tenofovir resistance Entecavir* Continue tenofovir (TDF or TAF) and add entecavir
Multidrug resistance Tenofovir Combined tenofovir (TDF or TAF) and entecavir*
*

Efficacy appears similar with switching to an antiviral with high genetic barrier to resistance and without cross-resistance versus combination therapy with follow-up periods to 5 years. Thus, switching is the preferred strategy except if HBV is multidrug resistant.