I had a question on HBV drug resistance. How does drug resistance work in case of vemlidy or entecavir? I recently started my treatment since my ALT was slightly elevated 35. However i am worried about drug resistance and what would happen if virus mutates to vemlidy. Is there a very specific case when there was drug resistance reported for vemlidy or does it happen at random? Also is there a possibility if my partner was lamvudine resistant and now i got an infection of the same virus who was lamvudine resistant or is it different for every individual?
Hi @Ash_Malhotra,
Drug resistance rates among the 3 first lines of antiviral treatments are very low compared to Lamvudine and other antivirals used decades ago. There is no evidence for resistance among TDF or TAF at this time, but we don’t know what might happen years down the road. Entecavir has very low drug resistance rates which occur around year 2 (less than 1% ) in naive-patients. Lamvudine is not used in most western countries to treat HBV anymore due to its higher rates of drug resistance.
I found this article from 2019, I hope you find it helpful. Thanks, Bansah1
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Agree with this analysis. See also previous threads on this:
- Why hepb virus seldom become resistant to tenofovir
- Drug resistance?
- Drug resistant hep b patient infecting others
Cheers,
Thomas
I have not been active on this community page for a while now but I thought I would share my story on drug resistance to Vemlidy as I’m obviously in a rare category. I started on Entecavir in 2020 due to a rising ALT. I developed a severe skin rash and thought it was a allergic reaction to the drug. I asked to be switched to Vemlidy. I still had a rash but it was controlled with an antihistamine.
My viral load slowly decreased in the following year but did not reach undetectable levels. Then it started to increase in 2022. My specialist ran a resistance test on my virus and found two mutations that were resistance to Tenofovir but not Lamivudine. I am now on both meds and my viral load has gone to undetectable levels but I understand I am prone to develop resistance to Lamivudine as well. Unfortunately uncertainty is the life on someone with HBV. I thought I would share me story in case anyone else finds themselves in a similar situation.
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Hi @wml,
Sorry to hear about the challenges you’ve faced. We appreciate you sharing this, as it will help increase awareness. Yes, Lamivudine is known to raise issues of mutation, so it is not a first-line treatment in the US, for example. I hope you continue to feel better. I agree with your sentiment about the life of someone living with HBV. Nothing is guaranteed, but we will continue to do our best.
Keep us posted on your progress. Best, Bansah1
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Thank you for sharing your story. @wml Im sorry that you have gone through this.
It’s hard enough having HBV without knowing you could become resistant again.
That just makes it worse.
Are you taking care of your liver? eating well, exercising, watching your stress levels?
Sounds like you have a knowledgeable doctor.  
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Thanks @Bansah1. Perhaps like me you feel anxious every time you check your blood test results. It’s comforting though to be on this journey with others who can relate to the challenges of living with HBV. Hope you are doing well and continuing your impactful work with the foundation. I also hope that one day our paths cross again.
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Thank you @Caraline. I remember your kind and compassionate responses on the HBV email list from a long time ago.
It sounds like you are doing well which is great!
Yes, I am taking care of my liver and do not have signs of fatty liver. I exercise daily and I’m careful with what I eat. I don’t drink alcohol. Stress though is more difficult to control due to family issues.
The good news is that after I went on Lamivudine my liver enzymes finally decreased to normal levels and my liver function tests improved.
I am grateful for the latest in medical technology. My specialist said that they unlikely would have picked up this mutation not that long ago.
Take care of yourself.
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Hi @wml,
Yes, I do sometimes consciously. Most of the time, I try to push it to the back of my brain and not think about it. However, I do feel that build-up too when it comes to checking my lab results. You are definitely not alone. We all experience this in some form.
This community helps do that. We try to walk with everyone as they process and journey through HBV life. It is great that we can support each other and understand what each of us is going through. This is the idea behind @ThomasTu’s decision to create this community. I am glad to hear you find it helpful.
I am managing as best as I can in my little town. Thanks for asking. Yes, I have been able to continue my volunteer work with the Hepatitis B Foundation. They are great to work with. That would be wonderful if we could all meet together in person one day. I hope it happens. Best, Bansah1
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Hello! I hope you’re well, my friend.
I started taking TDF about three months ago and I’ll be having my viral load checked soon; I already have the request. That’s always a concern.
I read somewhere on the forum that the medications, especially TAF and TDF, target parts of the hepatitis B virus that practically eliminate the possibility of mutation.
Do you know what type of virus it is? Here in my country, we hardly ever do this test to determine the exact type of virus. In my case, I only know it’s a mutant virus due to the HBEAG negative.
If it’s not too much to ask, I’d appreciate it if you could keep us informed about you.
Well, I’ll be praying that everything goes well!
Best regards
Thank you @wml for your kind words. I can relate about family stress. 
I don’t think my family would describe me as you have. So thanks again.
I’m glad your liver has settled down to normal and you are looking after yourself. That’s important.
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