Bibliographic information
Recommendation
Second-line antiviral (for chronic hepatitis B infection) therapies for managing treatment failure. Among people with evidence of treatment failure due to confirmed or suspected antiviral resistance (based on history of previous exposure or primary non-response) to lamivudine, entecavir, adefovir or telbivudine, switching to tenofovir disoproxil fumarate is recommended. Tenofovir alafenamide may be considered as an alternate regimen, if available
Recommended in favor
Strong
Certainty of evidence
Low
Notes and Remarks
a Treatment adherence should be reinforced for all people with confirmed or suspected antiviral resistance. b Some countries and health-care providers may consider switching people to TDF (or TAF, if available) from existing antiviral regimens with a low barrier to resistance before evidence of treatment failure, but these guidelines make no formal recommendations. c To date, there are only isolated case reports of TDF or TAF resistance when used for hepatitis B treatment. If there is primary nonresponse, then treatment adherence should be reinforced and monitored. At present, there is therefore no indication to switch to an alternative drug regimen.
Also Featured In
This recommendation also appears in the following guidelines:
Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection