Hep B and pregnancy

[richardt112]

Hello,

My wife is a chronic Hep B patient currently having treatment with Lamivudin and Adevofir. For the past one year or so, her DNA test shows undetected (or zero) copies of the virus. Her ALT and ultrasound tests so far have been good too for the past one year or so.

Recently we would like to have a baby, and according to our doctor, Adevofir is not tested for pregnant women. The doctor explained to us that if we would like to have a baby, my wife will have to stop using adevofir which will most likely cause her liver to deteriorate as in high virus count, high ALT number etc.

We are somehow caught in a dilemma here. What should we do? Does any of you face similar problems with Adevofir treatment and having babies?

Thanks and have a good day.

[zellyf]

stevenNYer is pretty knowledgeable about treatment drugs and treatment in general.  

Questions:

What is your wife's disease history?
What is your wife's e-antigen status?
How old is she?
Does the doctor have an endpoint for treatment?

[richardt112]

What is your wife's disease history?

My wife, 30, is a Hep B carrier since she was borned. In 2002, after the ALT test revealed that her ALT level is high, the doctor prescribed her with Lamivudin. 2 to 3 years later, the virus mutated and the doctor recommended my wife to take Adevofir together with Lamivudin.

Her doctor did not give an endpoint for the treatment. He mentioned that my wife has to continue to take both Lamivudin and Adevofir until she has developed the antibodies. Somehow it is a catch-22 situation. According to the doctor, if she stops the medication, the virus count will definitely increase. However, if she doesn't stop the medication, it is almost impossible to have a baby and there is no endpoint to this treatment.

I will check her e-antigen status as I do not have her medical report with me now.

[zellyf]

Okay,  I think Steven will be able to help you with some of this.  Sounds like the endpoint is achieving the e-antibody and that she has already achieved e-seroconversion (e-antigen negative).  

Steven?

[stevenNYer]

Unfortunately, in 2002 when your wife first started with Lamivudine, antiviral treatment was still somewhat new and probably didn't fully understand what resistance means (and sadly some still don't).  And in 2002, Adefovir was approved for treating HepB.   Lamivudine has has a poor resistance profile.  We know that now but can't turn back the clock.

Now, I am NOT a doctor.  But I read that Telbivudine is okay to use during a pregnancy.  So ask your wife doctor about that option.  Is Telbivudine effective with Lamivudine resistance?, I don't know.

If the doctor has valid reason why meds should be used during a pregnancy, then I would ask for a biopsy to assess damage.  If liver is in good shape, maybe ask the doctor to stop meds for duration of pregnancy and hope for the best.  I mean many people don't know they have HepB, have several kids, and liver is still fine.  I know these are hard decisions.

Also if there is no pregnancy consideration, I would strongly advocate for a switch of Adefovir to Tenofovir.  Tenofovir will be FDA approve for treating HepB hopefully soon.  It is similiar to Adefovir but much more powerful with a better resistance profile.  Resistance to Adefovir start to creep up after year 3.  And once that happens, that will compromise Tenofovir as a treatment option.

Good luck.

[stevenNYer]

It was late last night and I left out some words in my post (must be tired and half asleep).  Here are some corrections:

Unfortunately, in 2002 when your wife first started with Lamivudine, antiviral treatment was still somewhat new and DOCTORS probably didn't fully understand what resistance means (and sadly some still don't).

If the doctor has valid reason why meds should NOT be used during a pregnancy, then I would ask for a biopsy to assess damage.