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KMID : 0816120120150020063
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Korean Journal of Pediatric Gastroenterolology and Nutrition
2012 Volume.15 No. 2 p.63 ~ p.73
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Strategy to Overcome Drug Resistance That Develops during Treatment of Chronic Hepatitis B in Children
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Hong Suk-Jin
Choe Byung-Ho
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Abstract
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Development of antiviral resistance to lamivudine is the most important factor for the treatment failure. It is necessary to establish proper guidelines to overcome drug resistance for children with chronic hepatitis B. Primary treatment with lamivudine should be considered if patients are in immune-clearance phase and have persistently elevated ALT levels more than twice the upper limit of normal value. Before initiating the therapy, careful consideration of the patient’s status is required to exclude abnormal liver function tests due to other causes. The treatment option should be carefully decided to suppress the viral replication effectively. To obtain good compliance, clinicians should educate patients and their parents. Appropriate monitoring for virologic breakthrough and genotypic resistance is important in deciding to change the treatment plan. Sequential monotherapy should be avoided and a combination of drugs in other categories is recommended. New antiviral agents, such as entecavir and tenofovir, which have high potency and high genetic barrier, are soon expected to be available for use with children.
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KEYWORD
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Chronic hepatitis B, Antiviral agents, Drug resistance, Children
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