Copyright ©2014 Baishideng Publishing Group Inc.
World J Hepatol. May 27, 2014; 6(5): 284-292
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.284
Table 1 European Association for the Study of the Liver guidelines compared to other international guidelines
CriteriaEASL 2012[6]AASLD 2009[7]APASL 2012[8]
HBV DNA treatment threshold
HBeAg(+) (IU/mL)20002000020000
HBeAg(-) (IU/mL)20002000-200002000
ALT treatment threshold> ULN> 2 × ULN> 2 × ULN
Liver biopsyModerate to severe necroinflammation or fibrosisNot applicable (consider in certain groups)
Table 2 Main advantages and disadvantages of pegylated interferon alpha and nucleos(t)ides analogues in chronic hepatitis B[6]
Peg-IFNNucleos(t)ides analogues
AdvantagesFinite duration (usually 48 wk)Potent antiviral effect
Higher rates of anti-HBe and anti-HBs seroconversion with 12 mo of therapyExcellent tolerance, good safety
Absence of resistanceOral administration (once daily)
No contraindication for treatment
DisadvantagesModerate antiviral effectUnknown (perhaps indefinite) duration of treatment
Inferior tolerabilityRare HBsAg loss
Risk of adverse eventsRisk of viral resistance
Subcutaneous injectionsUnknown long-term safety
Contraindications in specific patient subgroups
Table 3 Cross-resistance data for the most frequent resistant hepatitis B virus variants[43]
L180M + M204VRRISS
A181T/V + N236TRRSRR
L180M + M204V/I ± I179T ± T184G ± S202I/G ± M250I/VRRRSS
Table 4 European Association for the Study of the Liver 2012 Guidelines recommendations in resistant patients[6]
LAM resistanceSwitch to TDF (add ADV if TDF not available)
ADV resistanceIf patient was NA naive before ADV: switch to ETV or TDF;
ETV may be preferred in such patients with high viremia
If patient had prior LAM resistance: switch to TDF and add a nucleoside analogue
LdT resistanceSwitch to or add TDF (add ADV if TDF not available)
ETV resistanceSwitch to or add TDF (add ADV if TDF not available)
TDF resistanceTDF resistance not detected to date: add a nucleoside analogue
Switch to ETV if patient had no prior LAM resistance or add ETV in patients with LAM resistance