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Hapatitis B

I have taking Baraclude for 14 months, previoulsy my blood result showns Hep BE Antigen negative, 0.0901 meanwhile Hep BE Ab showns positive, 0.028. My doctor advised me to continus taking for another 2 years but yesterday my blood results indicate that my Hep Be Antigenn back to Positive, 23.28 and Hep Be Ab positive, 0.269. What does this mean? Is it virus is resistant with Baraclude? Should  I continue and is there any change for it to back to zero conversion?
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Avatar_n_tn
I think resistance occurs when your HBV DNA rebounds.  HBeAg and HBeAb sometimes fluctuate when they are on borderline. Just an opinion. I'm not a doctor.
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Avatar_m_tn

it means entecavir is losing efficacy but for resistance we need the following:
1 log hbvdna rise
hbcab Igm higher than 0.2s/co
mutation genome test

but i wouldn t wait for 100% security of resistance add nitazoxanide as soon as possible, it is effective also on hbv mutated strains and after 4 weeks add tenofovir and slowly discontinue entecavir or keep combo of both

did you have previous resistance or used antivirals before etv?is hbvdna und?

i am also on etv but added ntz at 4th month since hbv dna still detectable, i would never risk monotherapy

ntz even monotherapy on hbe neg and hbeab pos makes hbvdna und in 2-3 weeks

also note that tenofovir has no resistance detected in about 4 years so much more safe than entecavir
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Avatar_m_tn
Hep Be Antigenn back to Positive, 23.28

this is a big rebound, 23.28 is alot, check hbcab Igm quantity this is the most sensitive test, much more than hbvdna, if you find it close to 0.2s/co you are rebounding

in any case add ntz and check after 12 weeks if hbsag declines (hbsag negative/hbsab positive=virus eradicated and no more durgs)
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Avatar_f_tn
Why  tenofovir is more safe than entecavir?
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Avatar_m_tn

tenofovir is safer because no resistance has been detected until now, 4 years, all the other antivirals start with resistance from less than 1 year especially if hbvdna is not und by 6 months

entecavir has 0.2% from first year and 1.2% at 3 years, tenofovir 0% even if hbvdna is still high-it is very probable that no resistance will be detected for a lot of time, the reason why this happens is not known.

entecavir in case of lam resistance has very high resistance in a short time, much more than 40% 3 years and more than 50% 5 years

unfortunately guidelines have made this clear only in 2009/2010 so many people with poor medicine culture, and who trusted docotors not expert enough, have got damaged.

in anycase  whenever possible and if not uncompensated cirrhosis or severe damaged liver, it is better to try immune modulators first (interferon, nitazoxanide) before being slave to these antivirals for life
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Avatar_f_tn
stefano, thank you.
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