Double anti-viral therapy with Tenofovir and Entecavir is not recommended since the use of just one of the two drugs is effective for viral replication suppression while the combination of the two drugs has only one effect: to double the cost of the therapy.

In a recent RCT from south east asia there was no difference between the effect of tenovir plus entecavir versus tenovir alone in patients resistant to entecavir

What about in lamivudine experienced patients and now detectable vl?

Just use tenofovir. Remember to check renal function before you start and then monitorate it more carefully the first year. Later renal function monitoring is necessary once a year.

Thanks, already doing that. Was wondering what people have experienced in their clinical practice and observation

In Japan, tenofovir is added to entecavir when entecavir effect is not sufficient enough to eradicate HBV-DNA. I have two HBV-related chronic liver desease patients (chronic hepatitis and LC+HCC) in which tenofovir was added on to entecavir for eleven months. In both patients, reduction of HBV=DNA level and HBeAg titer were prominent compared to the periods of entecavir alone therapy.   However, I wonder whether dual therapy with tenofovir/ entecavir are sufficient enough to HBeAg/Ab and /or HBsAg/Ab seroconversion.

 the process of Anti-Hbs seroconversion isnt facilitated even by double anti-virals.Thats the irony of it. Theres still a very very low percentage of chronic hep b patients who develop Anti-Hbs on treatment. And by the way, withdrawing either of the drug is a little redious..isnt it?risking rebound Viral load increase and flare of hepatitis?

There are no good biomarkers for withdrawing one of the drugs in whom tenofovir/ entecvir dual therapy are performed. I have no idea what will happen to patients in whom one of the drugs are withdrew. In both of our patients, there were no sign of entecavir resistance.

Well thanks for your worthy opinions...i guess this is a unchartered territory and maybe there will be some work on it in the coming time. Luckily resistance against entecavir and tenofovir is not rampant

Agreed with Kunio, Entecavir and Tenofovir combination for those with multi drugs resistant strains (AASLD 2014).

Many years ago, Lamivudine and Adefovir combination was recommended for those with Lamivudine resistance. However, its use was declining due to its high resistance mutation.