40 y.o. hbv hbe- from childhood most of the time inactive hbv with very low hbvdna. on november i found a flare of alt at 500ui/ml (it was probably higher because it was already regressing to low alt/low hbvdna) and fibroscan at 15.9 so started entecavir imediately.I fear resistance very much even if only 1,2% and want to start combination entecavir+tenofovir after 1years of therapy to prevent resistance. most researchers and liver specialsts at harvard are starting considering combo in cirrohsis, do you agree with this combo vs monotherapy? all liver functions are normal, only ggt and alt were abnormal when i had high alt. at 4 weeks of entecavir alt is 58ui/ml and hbvdna 4200ui/ml thank you

As an infectious disease doctor, I tend to think about combination therapy in patients with very high viral loads. However, your viral DNA is already low at 4 weeks of treatment so I suspect you will quickly suppress on this potent drug. As long as your virus is suppressed you will not be at risk for resistance.