Finished with my Liver Doctor

[hepbcurepls]

Just finished appointment with my liver doctor. He is pretty well known in the community. He advised me to take ectecavir right away. These are my results

DNA - 5190
Hbeag -
anti hbe +
bc / pcb mutation - have both =/
genotype c

On my mothers side my uncle had 1 hcc mass and it was cut. He advised me since hcc and genotype c with bc / pc mutation I should take ectecavir right away. He wanted to give me Tenofovir but since my kidney function is not that good with 1.28 serum creatinine he felt ectecavir was best choice for me. I wanted to try telebvuidine but he did not want to prescribe. I told him I could benefit maybe with a combo telb / tenf as seen in some studies. He said ectecavir did not cause nephrotoxicity, but from some of the things I have researched online it showed tenfo and ectec had same decrease in kidney function. The good thing is he has a fibroscan in his office. That was amazing to see. He said all his patients get a fibroscan which i have scheduled for next week. I am worried about the ectecavir worsening my kidney function. I dont want to be dialysis and hep b. Any advise?

[twinboys1girl4me]

I too read the same as you.  I found this article interesting below.  Maybe you could talk to your doctor about this article/roadmap as to a treatment plan.  I believe mutations on treatment come into play when the viral load is not suppressed, but if you are on top if it and test VL every 3-6 months then you will catch a resistance.  From what I read (same as you did) if you need to add on Viread to Telbivudine it may actually improve your kidneys.  


http://www.hivandhepatitis.com/hepatitis-b/hepatitis-b-topics/hbv-treatment/3582-easl-telbivudine-effective-for-hepatitis-b-patients-selected-with-qroadmapq

[hepbcurepls]

I had my GFR checked in 2009 and it was 1.5 , which put me at about 50 gfr. I did a 24 hour urine and creatinine clearance came at 93. The issue is I have some microalbumin in the urine which indicates damaged kidneys. I had uncontrolled high blood pressure for close to 10 years and got it under control in 2009. It took switching 3 different medications before finding the right one to get it right. I also noticed research papers which state that ectec has same kidney toxicity as tenf. I was hoping dr would give me teleb first and if I build resistance and tenf. Telbv has been proven to increase egfr and somehow protect kidneys. It has also showed that tenf / telbv monotherapy is just as strong as tenf by itself, thus still protecting kidneys. I believe ann lok has a paper recently with that information. I wonder if being bc / pc mutation will cause fast resistance to telb. Will it also create polymerase resistance? I feel like I might need to choose between the lesser of 2 evils.

[twinboys1girl4me]

Have you had your GFR and urine Creatinine checked to make sure you do have reduced kidney function?  You shouldn't go off blood Creatinine levels alone, as they can be normally increased if you have high muscle mass or are a younger male (due to muscle mass).

I've read conflicting studies about kidneys.  Many studies say there is no difference in kidney function change between Viread and Entecavir.  You have to remember, many studies of Viread come from HIV, where they take many medications at once which all puts a strain on kidneys.

My opinion and if I were you, I would take an antiviral due to your increased viral load (above 2,000 iu/ml hbeag negative), Genotype C, mutations which have increased risk of HCC, and family history of HCC.  I too would get fibroscan and take other tests for kidneys, to make sure there really is or isn't an issue.