Baraclude vs. Viread

[AsianMale]

Hi All,

I am an male in my mid-20's of southeast Asian decent, and I'm quite torn about how to proceed. I acquired HBV through vertical transmission and am currently in the immune clearance phase.

My ALT levels are 5-6 times normal.
I am e-antigen positive, e-antibody negative.
My viral load was 30 million in Oct 2008. Since then, I've been taking a cocktail of herbs intended to treat hepatitis (including milk thistle) and in Jan 2009, it is now 13 million.

I am torn because my family would like me to stay with herbal cocktail, but several doctors want me to begin treatment. The doctors say the fluctuation in viral load is natural and not necessarily tied to my use of herbs.

Firstly, has anyone had success with the herbal remedies?

Secondly, if I begin treatment, the goal would be sero-conversion (i.e. e-antigen negative, e-antibody positive). Would that essentially mean I'm cured and won't need to worry about HBV anymore?

Thirdly, my doctor says it's pretty much a flip of the coin to decide whether to go with Baraclude(entecavir) or Viread(tenofovir). There seems to be very little data about the success rate of either. Can anyone please help me to decide which route to take? For example, comparison of side-effects, success rate(i guess that means sero-conversion) in asians, etc.

And finally, how much of a difference would it make if I start treatment now or in, say, 6 months?

Being 25, I will potentially be taking this pill for many many years, so I'd like to make the right choice.

I'm new to this forum and would very much appreciate your time.

[zellyf]

Hang on.  I want stevenNYer to see this.  He'll pop in soon with some advice for you.

[cajim]

If antiviral is the route you choose, then your ALT and VL reading match the 2007 guideline recommendation for treatment.  Both Baraclude(entecavir) or Viread(tenofovir) are effective in this line of treatment.  When you choose the latter, you need to keep an eye on your creatine level (kidney damage indicator).

[cajim]

"Firstly, has anyone had success with the herbal remedies?"

I am trying a non antiviral remedy but it will take 2 years to see the result.

[AsianMale]

Thanks for the response. Then why would I choose Viread at all? Why not just go with Baraclude? Is Baraclude supposed to be safer?

[cajim]

Because Baraclude has its own headaches, e.g. the Chinese HBV site often mentions concerns about Baraclude relating to cancer.

[stevenNYer]

Welcome to our forum.  It's nice to see a first time poster having done some research and learning for himself before asking questions.  It just makes it easier and more meaningful when we don't have to explain the basics.

Firstly, I think herbal remedies are okay to use to support liver functioning.  But don't expect it to help you "e" or "S" Seroconvert.  In terms of stats, it's not going to happen.  It also won't limit or stop viral replication.  You labs pretty much proves this point.  

Secondly, even if you successfully "e" Seroconvert in time, you still need to monitor your condition.  Disease "re-activation" is common among "inactive carriers", especially over time.

Thirdly, choosing between Tenofovir (Viread) and Entecavir (Baraclude) is like flipping a coin.  Both have good antiviral power.  Both have minimal side effect.  Both have little things to worry you a little (as pointed out by cajim's post).  Neither have research showing negative effects of long term use for HepB.  So far so good.  If you could only get your hands on one (depending on your insurance coverage and wallet size), either one is fine....But if you could afford both, do both.  Given your high viral load, do all you can to minimize risk for antiviral resistance.  Combo it to x-fold the antiviral power and down the DNA quickly so the virus loses its adaptive power (that is has in large numbers...13 million in your case).  Combo until you "e" Seroconvert or even until you reach UND DNA and go mono with either Tenofovir or Entecavir.  You will buy your med more time this way.  As you say, you may need to take this for a long time.  You need to protect you cross-protect your meds to make sure it works for a long time.

Finally, if you made a good guess by a series of labs that you are in immuno-clearance phase, treat it.  Waiting 6 months won't make much of a difference but why wait.  You ALT shows you your liver cells are taking a hurting.

And welcome to my boat...the "e" Seroconversion could take time...I know...all to well....

Good luck to you.  Stick around and let us know how you are doing.

[AsianMale]

Thank you for your lengthy reply. I tried to go back and read some of your posts since it sounds like you have a good amount of experience with HBV, and I am quite impressed by the thoroughness of your posts. Your dedication to helping the community is really quite touching. How long have you been trying to seroconvert?

Viread offers a 5% chance of loss of HBsAg in 48 weeks while Baraclude offers a 5% chance in 96 weeks. Do you think it's safe to conclude that Viread has a higher chance than Baraclude of wiping out the virus?
Also, since Viread and Baraclude are both meant to lower the viral load, it seems treatment should be combined with Pegasys (which provides roughly a 10% chance of "s" antigen loss) to boost the immune system for maximum efficacy...at least that's what my common sense tells me since Pegasys is most effective when ALT levels are elevated and viral load is low. I mean, isn't that what we all ultimately want? To lose that "s" antigen? Losing the "e" antigen still means lifelong bloodtests...

I feel somewhat uncomfortable taking both Viread and Baraclude. Is there conclusive data showing the safety of taking both simultaneously? Is that what you're currently doing? If so, have you noticed any side effects with either? or both?

Also, does anyone know where the magical Indian herbal cure for hepatitis stands today?

Thanks again for your last post. It's nice to know we're not alone in this seemingly never-ending journey...

[AsianMale]

For Viread:
"...by week 96 of Study 103, 6 percent of all patients continuing treatment in both groups experienced “s” antigen (HBsAg) loss, which contributes to resolution of chronic hepatitis B infection (HBsAg seroconversion rates were 4 percent among patients originally randomized to receive Viread and 5 percent for patients who rolled over from Hepsera)."

For Baraclude:
"treatment with entecavir for up to 96 weeks (n = 354) resulted in...2% for HBsAg seroconversion (5% for HBsAg loss)"


According to these studies, seroconversion of "s" antigen is more likely with viread (4%) than with Baraclude (2%). Either way, the chances are low, but I prefer 4% low to 2% low. :)

Thoughts?

[zellyf]

AM,

My own approach is to not continuously strive for the Holy Grail of an "s" seroconversion which occurs at a rate of 1% a year.  Instead, when the time comes for me to choose a treatment option I will focus on disease management with the best long term results based on currently available data.

[stevenNYer]

I found out that I have chronic HepB by chance in 2005 and treated and waiting to "e" Seroconvert since then.

Forget "s" Seroconversion,  1%, 5%, whatever, I don't expect it to happen.  Disease management is the way to go.

As for the "herbal cure", countries where Hep B is endemic all have magic "cures".  Bottom line is they don't work, otherwise they won't have a HepB problem.  Did this logic lose anyone?  Be warned and spend your money wisely.

It's interesting that you mentioned pegsys.  A good treatment strategy is to use use pegsys to bring down the DNA, then use mono-therapy with either Tenofovir or Entecavir to keep it UND.  This strategy is also to keep the risk of resistance down.  

I didn't consider pegsys for myself because I can't risk the side effects, since I am, as they say in the "prime of my life". Just too much things to do and if I can't do it, it puts too much pressure on my family.  For chronic carriers, the expectation for treatment should be to reach inactive carrier status or stay UND.  Interferons or antivirals?  Antivirals for me.

So listen, naturally I get 1%,  Entecavir gets 2%, Tenofovir gets 5%, since I am combo-ing with these meds, does that mean I have a whooping 8% chance to obtaining the Holy Grail?  Hahaha.  You have to be realistic and have a sense of humor in this.  And I'm fine combo-ing.  I'm still here and kicking (and avoiding those, windows, and I had sex with a pro and I worry about HepB posts).  And No sides.

[AsianMale]

Hi Steven,

If I were to go ahead with the Viread/Baraclude combo therapy you suggested, is there an optimal dosing of each that you would suggest? Do the "experts" agree on how many mg of each?

Thanks!

[cajim]

Not sure, but maybe:

Viread 300mg/daily
Baraclude 0.5mg/daily

[stevenNYer]

For this particular combo, Cajim is right.  Tenofovir 300mg daliy and Entecavir 0.5mg daily.  Tenofovir should be taken with food.  Entecavir should be taken with empty stomach.  They should be taken 12 hours apart from each other.  I take Entecavir first thing when I wake up.  Breakfast 2 hours later.  Tenofovir I take with dinner.  You should find a schedule that works well for you, if your MD decides to go with this combo for your particular case.  Good luck.

[Sharp7]

To those worried about the side-effects of pegasys, this has been my experience using pegasys since Apr 2008:
My baseline WBC count was 6000+. It has gone as low as 2800, but usually hovers between 3500 and 4500. My Neutrophil count has never fallen to an extent that would require me to alter the dosage or stop the meds.
My baseline platelet count was 200,000+. Though in the normal range now, has at times touched 110,000. Again, not low enough to alter the dosage.
I've heard that many people get fever every time they administer peginterferon. I ran a fever of 102F on the first day that I was injected. Never again.
What else? Weight loss: baseline 67Kg. Now 58Kg. I see no reason I should be worried.
Baseline height 177cm. Still the same ;-)
Anything else? Hair-loss! I've lost a little bit, I suppose. I don't know how much, and I don't care.

The reason I post all this: if some of you are worried about starting peginterferon, and the only factor holding you back is all the scary things you've heard about it, well, here's some anecdotal evidence. It's been OK for me so far. YMMV. I was worried about the side-effects of peginterferon too. Before I started, I even used to think I might even get suicidal when I'm on this. One more thing: my meds supplier tells me that younger people tolerate this fairly well.

The good news so far: baseline HBV DNA level ~4,000,000 copies/ml. Currently below measurable range (<6000 copies/ml by PCR at this lab). But still HBsAg+, HBeAg+.
Baseline ALT: 152. Now 21.

PS: My intention was not to recommend FOR or AGAINST peginterferon or anything else. Just sharing my experience.

I'll probably start entecavir soon after I complete this.

[hepbinme]

Hey guys, I'm new to the forum -- I just found the thread through Google by searching Viread + Baraclude. My apologies if I ask a few stupid questions, I'm still learning a lot about HepB. =]

I want to start off by saying that I have been taking both Baraclude + Viread as part of a study. I will try to be specific as possible, but all my paperwork and results are back at home since I'm away for college. I'm 23 years old and found out I had chronic HepB. My first blood results were (taken in 07/18/2008):

HEPATITIS B VIRAL DNA, QUANT PCR            1630000000 H    <160 copies/mL

HEP B VIRAL DNA QT                                      341000000 H     <100 IU/mL

Can anyone help me with reading those numbers? I know they're in some type of units, both meaning the same count...I'm just wondering what figure I should be using to reference myself with everyone else, such as AsianMale's 30 million count.

I've been on the combo drugs for about 6-8 months? About a few weeks ago, I came back for my 3rd/4th? scheduled visit and to see my results after a 4 month interval (like I said, I'll get the exact date for everyone asap, sorry...). For now I'll type what I remember off the top of my head.

2-3? months on the combo:
HEP B VIRAL DNA QT                                      300,000ish H     <100 IU/mL

4 months later:
HEP B VIRAL DNA QT                                      800ish H     <100 IU/mL

At the moment, I'm HepBeAB negative, and HepBeAG positive.

Please feel free to ask any questions, and hopefully I'll be able to do the same as well as provide answers. Thanks everyone!

[cajim]

Can anyone help me with reading those numbers? I know they're in some type of units, both meaning the same count...I'm just wondering what figure I should be using to reference myself with everyone else, such as AsianMale's 30 million count.

--Your high HBV DNA usually means you are HBeAg positive.  Is that right?  If yes, your high DNA does not necessarily mean heavy liver damage.

What are your ALT and AST?

[Sharp7]

copies/mL is a more standard unit. I have seen the conversion of IU/ml change based on which specific PCR assay is used. I have seen some people use a x5 conversion factor, but one of the times I got the count report, the report specifically asked for a x7 conversion factor for copies/mL.

Most HepB journal papers use copies/mL (sometimes expressed in log10) as the unit of measurement (and very few use IU/mL or pg/mL). Based on that, when I see someone omit the unit, I assume they mean copies/mL.

[stevenNYer]

"hepbinme":

As per our forum rules, please copy and paste your question to a new thread.  We try not to take over someone else's thread.  This thread posting should be related to AsianMale's situation.   We'll be happy to reply comment to your own thread.

[hepbinme]

I apologize. I should read the forum rules...was too anxious when I found out that there are others out there relating. Sorry! =]

[joethestrong]

I'm 52 with VL 80 mil, normal liver function and biopsy, in immune tolerance phase [?]. I was suggested to start Baraclude because of age, got some severe side effects but continue on now for 16 months. VL. were down to 3,000 before rebounding to 12,000. and start adding on tenofovir.

I think this whole things of early general prevention could not be right. Monitoring should be better since I'm 52 and still ok. What if you start antiviral drugs in such and early ages and have to continue for very long time. Don't make sense. The professional have to find accurate risk of having cancer  to support the general prevention.

[cajim]

1.  When did you first test positive for hep B
2.  What treament(s) did you go through?
3.  At the time you started Baraclude, what were ALT and AST?

[joethestrong]

1.Didn't know when first contacted [ could be vertical.}. But first tested hbv positive 30 year ago, [ at 22 in univ.].
2.Normal ALT & AST, normal biopsy, consider to start tx. due to high viral load [ 80 mil.] and age in risk group.
3.Started with Baraclude 0.5mg 16 months ago. Start adding on Viread 300 mg 1 month ago.

[cajim]

I can see the logic of your doctor's starting baraclude.  How do you feel now?  normal eating, sleeping, working, family life?

[joethestrong]

If stop taking drugs is of great danger, then I think it's must be informed prior to the start of tx. so any patient can weigh his/her own risk.

[joethestrong]

I feel normal so far but begin to worry about the long term effects of both drugs. Want to quit the drugs, any suggestions?

[cajim]

"If stop taking drugs is of great danger, then I think it's must be informed prior to the start of tx. so any patient can weigh his/her own risk."

--Agree 100%

Want to quit the drugs, any suggestions?

--Absolutely have a doctor to follow and monitor you.

[bram44]

I was recently diagnosed with chronic HBV. With HBeAg(-) and HBeAb(+). Viral load 90,000 copies per ml.

All other tests seem normal. My doctor suggested to use Viread.

Can anyone in this forum suggest whether this is a better option than using Baraclude 0.5mg ? Especially side effects. Should I be using Baraclude first ?

Also I am taking Cholestoral medication (Niaspan 500mg +aspirin 83mg). My cholestoral levels are normal and thinking of not using the medication.

I was never treated and my AST ALT levels are at the high end of normal range (they were normal a year back).

Appreciate any suggestions.

BTW - I am from south India and presently have no symptoms and feel pretty healthy.

Thanks for posting very useful information.

-bram44

[cajim]

Viread, Baraclude, about the same in potency, side effects, etc.

Also I am taking Cholestoral medication (Niaspan 500mg +aspirin 83mg). My cholestoral levels are normal and thinking of not using the medication.

--Do not know enough to comment.

[bram44]

All the material I read so far is indicating HBeAg (-) the treatment is possibly life long. Why is this ?

Can one stop the treatment after achieving low levels of DNA and monitor the level ?
Are there any studies done on this aspect ?

Taking a drug indefenitely is a bit scary thought. It would be nice to understand the "rules" for stopping use of the medication (or restart).

My virus Genotype is A - if that makes any difference.

Are there milder versions of Viread or it comes in only one dose ?

cajim - thanks for responding. You have gathered a lot of useful informations for people like us.

[cajim]

All the material I read so far is indicating HBeAg (-) the treatment is possibly life long. Why is this ?

--Antivirals control only, don't cure.

Can one stop the treatment after achieving low levels of DNA and monitor the level ?

--Needs doctor's monitoring.

Are there any studies done on this aspect ?

--Many.  Type "flare" into google.

Taking a drug indefenitely is a bit scary thought. It would be nice to understand the "rules" for stopping use of the medication (or restart).

--Agree.  The cause is resistance to the drug.

My virus Genotype is A - if that makes any difference.

--Yes.  I remember reading something about it having a better chance to be cured (HBsAg(+)) with IFN.  Go through this:

http://www.medhelp.org/posts/show/492008

Are there milder versions of Viread or it comes in only one dose ?

--Not sure.

[bram44]

The following link gives lot of information on various tests etc...
You need to create a login (for North American users)

https://online.epocrates.com/noFrame/

[kaiming]

Hi All,

For those who have helped to educate me and provide support in this forum, I'd like to sincerely thank you. It's been about 6 months since my last post, and I'd like to provide an update to you and to anyone else who may stand to benefit from my experience. I know if I had access to someone in my situation 6 months ago, I'd be ecstatic and would have asked many questions. Therefore, I'd like to be as open and detailed about my experience as possible.

Since my last post, I decided to continue taking the herbal cocktail tailored to treat hepatitis and postpone treatment with Baraclude and/or Viread.

As of the end of June, my HBV DNA level was 200 million copies/mL; that's an increase of 187 million copies/mL in 6 months.

It was perhaps the most difficult decision I've had to make, but I did finally start taking Viread (solo therapy) on July 2nd. It was difficult for a variety of reasons:
- cost of roughly $1800 for a 3 month supply (what if i no longer have insurance?)
- possible damage to the kidneys (isn't a bad liver enough to worry about?)
- pressure from family members to take the natural approach with herbal remedies (what can I say, they're stubborn when it comes to western medicines with many side-effects)
- potential to end up worse than I started if the virus mutates
- one more crucial thing to remember to do everyday (as if my life isn't stressful enough)

I had decided to take the plunge to start treatment, and for my situation there were really only 3 options: Baraclude alone, Viread alone, or Baraclude-Viread combo therapy. The "benefit" of Baraclude alone is that if the virus mutates and Baraclude becomes less effective, then Viread can be added, as it has been shown to be quite effective as a "second line of treatment" in combination with Baraclude. The other two options seem to be resistant to virus mutation, though not much data is available and perhaps the test subjects just haven't been in treatment for long enough for mutations to occur.

Here's my interpretation. Baraclude is weak. If it fails to control the virus, add on Viread, the more effective drug. Or you can start with both. Or you can just start with the more effective drug. Known side-effects for each drug are about the same.

So I ask, why would I take both when Viread alone seems to be just as effective and resistant to mutation? If I take both, I'm risking potentially unknown drug interaction issues, more side effects, and a heavier financial burden if I lose my insurance. And why would I want to start with Baraclude, help the virus to become stronger, then try to fight it off with both when I could have not helped it to become stronger/different in the first place?

Thus my decision to go with Viread.

Now my experience so far:

Day 1: Took Viread in the morning with breakfast. No side effects until 11pm. Felt quite nauseous, had a headache, and had to lie down. After 30 min, the symptoms eased, and I went to bed soon thereafter.

Day 2: Woke up and felt normal, no more nausea or headache. Took Viread in the morning with breakfast. Again, no side effects until 11pm. Felt nauseous, but not as much as on Day 1. Light headache as well. Went to bed right away, since that seemed to help on Day 1.

Day 3-4: Took Viread in the morning with breakfast. No symptoms all day. Went to bed earlier to avoid the nighttime nausea.

I feel like I've been getting tired earlier since I've been on Viread, though perhaps it's just a coincidence that I've been really active these first 4 days.
If anything changes and I start experiencing side-effects again, I'll try to keep you posted.

Any feedback would be greatly appreciated regarding your experience, or the detail of my post. I'd like to keep posts as helpful and concise as possible.

-AM

[AsianMale]

I didn't realize my friend was logged in when I submitted the last post, but yes, it was indeed mine.

-AM

[bram44]

I was diagnosed on May 27. I had to undergo tests to ensure the side effects are minimum.

I read frantically a lot of information on Viread. Got my medicine, but was hestitating to start.

My doctor says this is not a life-time commitment, rather a long term commintment (possibly 3 years or less). Once the DNA level comes to acceptable level (if not 100% loss of HBsAg), regular monitoring is needed.

I started taking Viread on July 2nd (night after 09:00PM - I eat very late).

I stopped exercising (just doing minor streatching). I don't feel weak, but the anxiety or anticipation of stuff is more than the side effects.

I guess ignorance sometimes is a bliss.

My doc asked me to get Creatinine Clearance test done, to ensure the damage to kidney's is avoided, by adjusting the dosage.

Remember this drug is cleared by Kidney function and one should have sufficient muscle in the body.

I really wish there is a viable "natural therapy", but given our fast paced lives, we may have to live in an "Ashram" for months with strict diet and herbal remedies. I am not sure we have such a talent available in this day and age.

Wish you and all safe recovery.

[iaas]

Hi everybody,am a worried mom whose husband was dignosed with the chronic HBV  3yrs ago.He was on pagasus for a year.which he was doing fine but also lost a great amount of weight.his DOC then put him on the baraclude(entecavir)but he never paid attention to his medication and was drinking alcohol at the same time,till just recently he became seriously sick and was told the virus had flared up again.so he`s now on both baraclude and viread.Am so worried  now because he feels so weak and frail,his eyes  are yellow.They evaluated him at the hospital for a liver tansplant but was later told the results  of the liver biopsy was better than they thought.
since the hospitalization l`ve been going to the hospital with him every week to check on his labs.All they keep saying is enzymes are maintained but they have been giving him vitamin k injection for coaguation.
Am new with this  diagnose so i dont know much about the lab values but the next time we visit the DOC I`ll get some information to share with you all.
THANKYOU ALL for the information

[bram44]

It has been a little over a month since starting on VIREAD. First few days felt numb-feet. I noticed a little fat on the belly - may be I am eating much and not exercising.

One occasion I had couple of drinks and felt drowsy the next day (and did not feel like eating). One advise for people with HBV infection is to stay away from alcohol. But my doctor suggested "occasional limited social drinking" is ok.

I feel normal, like as usual. I will be getting viral load testing in October 1st week.

[Jasminetruong]

first of all, i'd like to thank everyone here that have posted their experience and to be honest, reading this  im experience mixed emotions. Firstly, relieved and secondly, afraid at the same time.

I was diagnosed two years ago but being me, i ignore every bloody test and advice from the docs. I saw a specialist about my condition in july 2008. Thinking that maybe i placed on a few kgs that increased my ALT readings. 6 months later, my ALT reading is still high. Therefore, i started treatment on Entecavir. I've been on that for 7 months now and because of the symptoms im getting such as hard of breathing and pain in the heart at times, the doctor prescribed me Viread. I'm worried about taking Viread and everything in the info pamplet is "unknown". I'm 25 and possibly in the next year of so or two years, might start a family. what are the effects ? I know its a NEWER version of entecavir. I'm waiting a call from my docter right now to ask him all these question but the last thing i need is another symptom. Entecavir has given my not only pains and discomfort in the heart but also discomfort in the bowels.

my alt reading is 28 which is normal but the hbv is still active hence, i need to continue taking this. man, this is going to be a long journey for all of us !!

Jasmine