Hep B Anti-Viral Treatment with Hepsera

[choppedliver]

My 70-year old aunt is going through an antiviral therapy for Hep B with Hepsera (Adefovir Dipivoxil):  10mg every 5 days.  She was originally taking it every 3 days but her kidney functions declined.  So she started taking 10mg every 4-5 days.  Now, her kidney functions are better (GFR in mid-40s from as low as 30 before).  

However, her last Quant PCR showed a virus count of 2,700 iu/ml (equivalent to 15,800 copies/ml), the highest in about 2 years.  The doc hasn't told her to go back to every 3 days yet.  But I'm wondering how significant this is.

I don't have all of her records, so I'm not sure how high the virus count was before she went on this anti-viral therapy.  Her ASTs and ALTs are always in the high 40s to low 50s.  Her AP is constantly elevated at around 200, while her GGT is around 60.  Her Ferritin and AFP tumor marker are in the normal range, if high normal.  She's also on a blood pressure medication since she has hypertension.  Treating one condition (Hep B) could worsen the other (CKD), so I'm wondering whether this is the right treatment.  

Is Hepsera the right drug to be on?  She has a liver ultrascan scheduled in a few months.  How acute is her Hep B, based just on her virus count and blood results?  She's had Hep B since her younger days, and her children also seem to be carriers (vertical transmission).  Once started, is it nearly impossible to be off the drug?  I'm more worried about her liver and possible complications down the road (HCC and cirrhosis).  But I want to know what the options are at this stage before things get worse.  Thanks for reading.

[stef2011]

you need a specialized lab, for example i am naive to antivirals but i have a secondary mutation which leads right away to lam and adefovir resistance since this mutation lowers response with this therapy

i have it done at a research center, i know main hospitals do it here in italy but don't know if same test, the name looks much like research not lab.did anybody have this test on our community?

name is "amplification of nested PCR of POL region" by die terminator and elettroforesis CEQ 8000
the test finds mutated hbv population>20%

anyway if you go with tenofovir you are safe with all muattions, none detected til now

[choppedliver]

Thanks for your reply.  Hepsera is not as safe as Entecavir or Tenoforiv?  I don't know about mutations: are they offered as part of her blood test?  The only thing shown is her Hep. B DNA virus count ("Hep B Quant PCR in IU/ML" or Quest Diagnostics' "QN, Real Time PCR" as Copies/ML).  Her count is from 2,800 iu/ml now (Hepsera 1 every 5d) and before her antiviral therapy, to 10-28, 35, and 700 when she was taking Hepsera once 3 days.  What test would you have to ask for to test her "baseline mutation"?  Thanks.

[choppedliver]

Thanks for your reply.  My aunt has had Hep B since her 20s or 30s, I believe, and her children contracted it perinatally.  It seems that a regular dose of Hepsera will damage kidneys.  Now she's taking 1 every 5 days, her GFR has gone back up to 45 from as low as 29 earlier this year.  But meantime, her virus count is now back to 2,800 -- I believe that is the level when she started her antiviral therapy.  Do you need antiviral therapy at that level?  

[stef2011]

very bad and weak antiviral, not on guidelines as firstline therapy only entecavir and tenofovir are and also safe

today i got the test of my hbv genome mutations and i have a natural mutation with reduced response with adefovir (hespera) and lamivudine, if i had started these i would be lost without cure now due to my baseline mutation

did he check for genome mutations that show resistance to antivirals?these mutations can also be present naturally although tenofovir has not shown any mutation at 3 years, entecavir has 1.3% mutation at 3rd year and then no more mutations until 6 years

hespera is high on mutation but don't remember percentage since not used anymore

[cajim]

1.  Hepsera is known to be heavier on kidneys.  How about changing to Baraclude?
2.  If she had HBV since young, she is considered very stable at 70 with current status.  Some people I read at the Chinese site just take care of eating and resting to stabilize liver condition.