HBV DNA detected again after stopping Baraclude

[ggtm]

I took Baraclude for 3 yrs 3mths and seroconverted to HBe neg/anti-HBe pos. and dna was undetected for about 2yrs. I recently stopped in March. But my recent lab results showed the dna is detected again.

March '12 - Stop baraclude
June '12 - hbv dna 1260 IU/ml
July '12 - hbv dna 966 IU/ml, ALT - 10

My dr said my levels are stable but may also cause liver damage over time. He mentioned the virus in my body belongs to the pre-core or core-promoter mutation group. And he also recommended me to take lab tests every month to monitor.

I wish to know what does "pre-core" or "core-promoter" group mean? What are the repercussions?

Does low hbv dna mean a lower risk of liver cancer?

What should i next do to improve my condition? continue to be on medication? or am I ok to stop and just monitor first. I am thinking of a natural treatment like taking phyllanthus niruri and thymus gland supplement. Anyone knows if it will help?

Appreciate your knowledge here...tks.

[calmama]

Yes, I am a mother of 2 children.  But I didn't have your dilemma when I was pregnant because my viral load was undetectable and liver enzymes were very normal.

I agree with StephenCastlecrag's advice about getting third, fourth,....etc. opinions until you find a good hepatologist you are comfortable with.

Although Tenofovir wasn't approved for Hep B until 2008, it has been used on HIV patients since 2001.  If there were issues regarding pregnancy, they probably would have emerged already.  However, almost everything is possible and I agree it's a hard decision.

[stef2011]

hbvdna is useless for liver damage, we have fibroscan today

hbvdna useless to see if you can clear hbv or if you have many infected cells, whatever the values there is no corrispondence at all

ast/alt liver damage, not at all, again fibroscan will tell

today hbsag quant is the most important with this you know the chances to clear the virus once and for all, the chances to get cured!and high alt which means active immune system especially if hbvdna is low/und

[ggtm]

good idea stef. I shld start a new thread on this.

but now, the question is whether i really need to be on medication or not.
I know for HBe-antigen neg patients, there's no clear end-point for treatment. And some guidelines suggest not starting on medication and just monitor and treat when necessary.

So now, I do not know if DNA 7000IU/ml is considered high enough to treat. This dr I just went yesterday says its low and only above 20,000IU and elevated ALT then should consider to treat with meds. But my regular dr says its a jump from previous 966IU and stable levels before, so may result in a flare (but so far my ALT has been very low fortunately)
Which is more accurate?

[stef2011]

it is best to make a new thread for all other members that had tdf on pregnancy to give feed back and possibly suggest a good doctor

i am not a doctor so i can only suggest:

since etv is not safe for pregnancy it is good to stop it as soon as pregnant like you've done

i d start tdf immediately, if your hbvdna was low/und tdf should start its effect on virus very fast

tdf has no resistance and there are no issues reported about pregnancy and i d not worry about this, i d start it immediately because we dont know if hbvdna can get und in 3months, 6 months or longer.

[ggtm]

Could I ask if you are a female too?

Im not so comfortable with taking tenofovir throughout pregnancy (unless benefit outweighs risk by a lot), because, though its a cat B drug, if you take it everyday, you never know how it interferes with the developing fetus, esp the first 8 weeks when the crucial developments are taking place. My 2nd consideration is, I do not trust drug makers in some ways as after 10yrs, they may suddenly change their stand after finding some abnormalities in pregnancy women taking tnf.

[ggtm]

Oh, and for sure, if I start tenofovir from 2nd or 3rd trimester onwards, I will take it for a long time, no more stopes definitely. I do not mind taking for life, as long as I do not develop resistance to it.