Management of lamivudine resistance: An overview

In the nineties, lamivudine (LMV) was the first nucleoside analog to be marketed for the treatment of patients with chronic hepatitis B virus (HBV). Following the advent of LMV, the management of patients with chronic hepatitis B, particularly those with advanced liver disease was markedly improved, with a substantial reduction in the rates of liver-related complications and mortality. In the face of excellent safety profile records of the drug, hepatologists had to face for the first time the issue of high rates of HBV resistance to therapy as the result of years of treatment of large cohorts of patients in the West and East. Initially considered no more than a virological problem, LMV resistance was later recognized to be a relevant clinical issue whose management requires specific therapeutic strategies. New, more active oral analogs have been marketed since, and new agents are to appear in the market scenario in the near future; however, LMV is still the number one prescribed anti-HBV agent worldwide for the treatment of chronic HBV patients, due to its limited cost, excellent safety and well predicted resistance profile.