Center for Hepatobiliary Disease and Abdominal Transplantation, UC San Diego Health System, San Diego, CA, USA.
Lancet Infect Dis. 2012 Apr;12(4):341-53. doi: 10.1016/S1473-3099(11)70314-0. Epub 2012 Feb 9.
Antiviral drug resistance is a crucial factor that frequently determines the success of long-term therapy for chronic hepatitis B. The development of resistance to nucleos(t)ide analogues has been associated with exacerbations in liver disease and increased risk of emergence of multidrug resistance. The selection of a potent nucleos(t)ide analogue with a high barrier to resistance as a first-line therapy, such as entecavir or tenofovir, provides the best chance of achieving long-term treatment goals and should be used wherever possible. The barrier to resistance of a given nucleos(t)ide analogue is influenced by genetic barrier, drug potency, patient adherence, pharmacological barrier, viral fitness, mechanism of action, and cross-resistance. In countries with limited health-care resources, the selection of a therapy with a high barrier to resistance is not always possible and alternative strategies for preventing resistance might be needed, although limited data are available to support these strategies.
抗病毒药物耐药性是决定慢性乙型肝炎长期治疗成功的关键因素。核苷（酸）类似物耐药的发展与肝病加重和出现多药耐药的风险增加有关。选择一种强效的、耐药屏障高的核苷（酸）类似物作为一线治疗药物，如恩替卡韦或替诺福韦，可最大程度地实现长期治疗目标，并且应尽可能使用。特定核苷（酸）类似物的耐药屏障受遗传屏障、药物效力、患者依从性、药理学屏障、病毒适应性、作用机制和交叉耐药性的影响。在卫生保健资源有限的国家，并非总是能够选择耐药屏障高的治疗药物，可能需要采取预防耐药的替代策略，尽管可用的支持这些策略的数据有限。
