ATTENTION!!!lamivudine/adefovir/telbivudine not approved for hbv monotherapy

since we see people who keeps using lam, adv, telbivudine with resistance development i think we must keep this thread always at first positions in the board so that as many people as possible can see this and hopefully avoid or change antiviral on time.

lamivudine/adefovir/telbivudine these antivirals lead to resistance and worsening of hbv and liver damage

lamivudine/adefovir/telbivudine these antivirals lead to resistance MAKING ALL OTHER DRUGS USELESS OR WITH LOWERED RESPONSE

ONLY INTERFERON, ENTECAVIR (BARACLUDE) AND TENOFOVIR (VIREAD/GENERIC TENVIR) ARE APPROVED AS FIRST LINE THERAPY, RECENT DATA SUGGEST ETV+TNF COMBO ON SEVERE LIVER DAMAGE/CIRRHOSIS TO PREVENT DEADLY FLARES ON RESISTANCE

it is necessary to make a genome test to detect mutations before starting antivirals to choose the most sensitive, resistance mutations are present naive before starting antivirals in 10% (but maybe more because people checked is small).
in genotype D muattion rtq215 (less response on lam and adv resistance maybe less tnf response but only seen in vitro and not confirmed in vivo) and other mutations are found, i don't know about other genotypes but probable about the same.

[cajim]

Sad, but just history repeating itself.  Why lamivudine/adefovir/telbivudine?  Because they came out first and there was longer time to collect their long-term effects.  Why not INTERFERON, ENTECAVIR (BARACLUDE) AND TENOFOVIR (VIREAD/GENERIC TENVIR) yet?  takes time.

[stef2011]

trial time is not needed to say they are complitely different drugs from first antivirals, it is genetic barrier to suggest the reason to choose etv or tnf, but according to virology we have to consider that even in etv and tnf case the mono therapy is a suicide, the best choice is to copy from hiv and hcv combo therapies

interferon cannot have any resistance, it doesn't act on virus so resistance is not possible on hbv
nitazoxanide is the same as interferon

[choppedliver]

Stefano, why are doctors still sticking to monotherapy with Hepsera or Lamivudine, then?  Are they just not keeping up with the latest research?  For someone who started her first antiviral therapy with Hepsera 1.5 years ago, do you recommend switching immediately to Viread?  Those test results recently released seem to indicate swithcing is probably the best option for someone who started with Hepsera?

Would it be another monotherapy or perhaps a combo with something else?  All my aunt has ever taken is Hepsera 10mg 1 every 3-5 days.  As another person said, are doctors just being conservative here?  Perhaps giving Viread some time to see if the lower resistance holds?  And concerns over kidney toxicity and perhaps osteoporosis?  Possibly more risky in this regard than the long-tested Hepsera?

[stef2011]

For someone who started her first antiviral therapy with Hepsera 1.5 years ago, do you recommend switching immediately to Viread?

absolutely, there are posts from HR, the researcher who cooperated to the discovery of all hbv therapies, he said hespera and viread are the same except for an atom which makes kidney damage and makes maximum dosage for hespera only 10g or mg don't remember, that was too low for hiv therapy and is too low for hbv too but they had to recover some money from the failure of hespera on hiv to cover research expenses.
do change it as soon as possible the only use of entecavir and tenofovir is not latest research but guidelines
1pill of viread has the same potency of a bottle of hespera plus if you develop resistance to hespera you won't be able to use tenofovir because they share same resistance

if yo want to higest security you might also combo etv and tnf, this is latest reserch data, because if you are hbvdna und it is not possible to check if you have developed hespera resistance although if you have resistance you should have hbvdna positive within months

why they use LAM, that's cheap for insurance, why they don't use interferon that's expensive for insurance.as you might notice in european countries where these drugs are free interferon is the most used first line therapy, LAM and ADV is not used since 2005 when etv came up and there was a lot of off label use of tnf in those years (tnf was approved late because they needed hespera on the market....) and europe was the first to approve it 2008, us follwed in 2009

As another person said, are doctors just being conservative here?  no they are mad, you cannot use hespera one every 3 days, resistance for sure....
tnf has very very mild sides compared to hespera and share same sides only much much more, hespera is a dead drug as my liver specialist said in my country you cannot use it anymore or i can sue the doctor

if you want the safest entecavir is the best although you must be sure you didn't develop adv lam resistance otherwise is not good anymore, resistance 1.2% on 6 years

tnf 0% resistance at 3 years, of course higher potency and resistance safety as etv

[stef2011]

hespera is not long tested, tnf is the more tested since used on hiv from 2000, please do change liver specialist and follow my advice on tnf or etv-tnf combo for maximum security

in case of adv resistance alinia and etv are still active although don't know how long etv can hold with an adv resistance

[Sharp7]

Would you like to add the warning to the welcome page? I will, if you don't. The welcome page has a lot that visitors to the forum should be aware of.

[stef2011]

please post it, i never noticed where welcome page is

[stef2011]

please post on welcome page also about active or inactive hbv hepatitis

http://www.kenes.com/easl2010/Posters/Abstract613.htm

http://www.gastrojournal.org/article/S0016-5085%2810%2900660-8/abstract

http://www.gastrojournal.org/article/S0016-5085%2810%2900660-8/abstract

[Sharp7]

I added the warnings, almost verbatim.

I did not add the links you sent about HBsAg quantitative tests. In my opinion, links for such detailed information belongs in a more specialized page: not many people are interested in such info (though I am). I also prefer it this way because this is meant for people who are new to the disease and/or the forum, and may get overwhelmed with too much information if we put a lot of details or links to journals, etc.

These pages are easy to find :-). Just scroll all the way up on this page until you see a link called "Health Pages". Our welcome page is called "HepB Introduction & Welcome Page". Anyone can go and edit it. You may not see the option to edit immediately... there is a thin, blue bar hidden to the right of the content section. Click on it to reveal further options and info.

A long time ago, I created a page called "HepB Research Info". I intended it to give quick links to journals, and not to individual papers. I propose that we modify it so that the links to journals stay at the top, and links to individual papers. ("Advanced users" of the disease would find both kinds of links very useful.)

[Sharp7]

silly me: I accidentally addressed the previous message to myself.

The links to the individual pages I mentioned above:
http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153
and
http://www.medhelp.org/health_pages/Hepatitis/HepB-Research-Info/show/939?cid=153

[stef2011]

thank you, very very good and clear both links

[stef2011]

up first position in the board

[stef2011]

up

[stef2011]

up

[hatecccdna]

How is your HbsAg now? We're expecting your good news.  :)

[stef2011]

i will check it in 2 weeks so we have result at the 12th week, the dream is 2logs drop but any result is ok if it keeps lowering

the last update is at 29th of may with alt decreasing to low normal range below 30, last hbvdna check is at 21st of my but i don't have result yet but probably und now

[stef2011]

i see this threads need to be always the first

i also think prople should strt to sue doctors who are using LAM,ADV or Telbivudine since guidelines are clear and only entecavir navie without any prior antiviral and tenofovir are safe, so all doctors making mess must pay for their mistakes

[stef2011]

up

update since doctors seeams to be the most ignorant about hbv, actually a research on US doctors confirms this....but i bet more countries are in the same situation

entecavir is approved as first line only for naive patients, it is not active if lam resistance mutation present which will emerge in a couple of years leading to etv resistance too

[stef2011]

up

[stef2011]

it is crazy in 2010 we keep seeing people on lam, i wish they take lam off the normal market since also in hiv is not so used anymore