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I'm 28 years pregnant and diagnosed with HIB
My liver specialist Doctor advised me my treatment for HIB (Hepatitus B) will start after I'm 32 weeks pregnant. His opinion is HIB treatment will clear the blood from virus and further reduces the spread of hib virus to babe. He advised to take Truvada medicine.
I have following questions?
1) Why use Truvada for HIB? Since Truvada is also meant for HIV patitents as well. Why not just use Viread ? My Dr. answered me Truvada is more safer to use at this pregnancy stage. Though i found online both Truvada and Viread have been categorized B level for pregnant women.
2) What confuses me further, Truvada is not even approved by FDA for HIB treatment?
3) This makes me crazy, that I've to take Truvada for lifetime, what if I've to be pregnant again?
4) Since I'm 28 years so far better off without medicine for any HIB treatment, it can continue further.
I have following questions?
1) Why use Truvada for HIB? Since Truvada is also meant for HIV patitents as well. Why not just use Viread ? My Dr. answered me Truvada is more safer to use at this pregnancy stage. Though i found online both Truvada and Viread have been categorized B level for pregnant women.
2) What confuses me further, Truvada is not even approved by FDA for HIB treatment?
3) This makes me crazy, that I've to take Truvada for lifetime, what if I've to be pregnant again?
4) Since I'm 28 years so far better off without medicine for any HIB treatment, it can continue further.
Hello. I'm 23 weeks pregnant and I found out I have this virus. I have been so depressed since last week and I can hardly eat and sleep. I don't know how to tell me family. I don't know how to face it. I'm afraid... How do you all cope?
Your doctor must have attended the meeting that i posted above. It clearly determined that immune tolerant phase women have a more rapid and effective clearance of HBv on Truvada compared with tenofovir. Thus he tries to treat you and protect your baby according to most advanced developments.
your VL of 116 million iU is equivalent to half a billion copies per ml. That is a very high viral load and you have a limited time to reduce that to the lowest possible level.
In most cases the extra potency of truvada over tenofovir is not needed. At a very high vl a combination with entecavir until undetectable status would normally be preferable, but this is not possible with entacavir, a drug that holds the potential to be integrated into the genome and cause permanent mutations. This is not the case with tenofovir and emtricitabine.
your VL of 116 million iU is equivalent to half a billion copies per ml. That is a very high viral load and you have a limited time to reduce that to the lowest possible level.
In most cases the extra potency of truvada over tenofovir is not needed. At a very high vl a combination with entecavir until undetectable status would normally be preferable, but this is not possible with entacavir, a drug that holds the potential to be integrated into the genome and cause permanent mutations. This is not the case with tenofovir and emtricitabine.
Hello,
In my report to locate, can you please tell it's full name so i can let you know.
In my report to locate, can you please tell it's full name so i can let you know.
Thank you. Are you saying going with Truvada is best for me as pregnant women than Viread? Please post any helpful comments / links that support use of Truvada.
What is your hbvdna and hbeag?
I still think tdf+hbv vaccine+hbig is able to prevent any chronic infection
I still think tdf+hbv vaccine+hbig is able to prevent any chronic infection
Since the viral load is so high, I think the doctor wants to give the baby the best possible chance to remain uninflected.
Several small trials with truvada have consistently shown a slightly increased power over just tenofovir. In a poster at one of the Hawaii hepatitis meetings this was analyzed and explained by improved intracellular pharmacokinetics towards the final effective compound when both drugs were simultaneously present.
I think Gilead is making an effort to get truvada approved for HBV.
Several small trials with truvada have consistently shown a slightly increased power over just tenofovir. In a poster at one of the Hawaii hepatitis meetings this was analyzed and explained by improved intracellular pharmacokinetics towards the final effective compound when both drugs were simultaneously present.
I think Gilead is making an effort to get truvada approved for HBV.
Participants were randomly assigned to receive 300 mg tenofovir once-daily, either with or without 200 mg emtricitabine once-daily, for 192 weeks.
Results
Viral load declined dramatically in both arms soon after starting treatment.
By week 192, significantly more people achieved undetectable HBV DNA (< 69 IU/mL) in the combination arm compared with the tenofovir monotherapy arm, 76% vs 55%, respectively.
About half the patients stopped treatment after 192 weeks, however, and their viral load returned to baseline levels.
Serological response rates were very low both arms.
6 tenofovir monotherapy recipients and 2 receiving the combination experienced HBeAg loss, and 5 and 0, respectively, had HBeAg seroconversion, but the differences did not reach statistical significance.
No patients in either arm experienced HBsAg loss or seroconversion.
In a univariate analysis, female sex, lower baseline HBsAg and HBV DNA levels, and use of combination therapy were associated with a greater likelihood of viral suppression.
In a multivariate analysis, female sex (odds ratio 6.0) and combination therapy (odds ratio 3.9) remained the only significant predictors.
Treatment was generally safe and well-tolerated.
6 people receiving tenofovir alone and 3 taking the combination regimen experienced adverse events, which generally were not considered related to study drugs.
No participants saw elevated creatinine levels or reduced creatinine clearance suggestive of kidney function impairment (a known tenofovir side effect).
No tenofovir resistance mutations were detected through 192 weeks.
"Prolonged antiviral therapy maintains potent viral suppression and is safe in immunotolerant patients," the researchers concluded. "The underlying impaired immune responses to HBV in this population may explain the poor serological response rates to antiviral therapy."
The treatment advantage for women in this study was stronger than the effect usually seen in trials of active chronic hepatitis, leading the investigators to suggest that, "Gender may be an effect modifier in treating chronic HBV patients with high viral loads and normal ALT values."
Session chair Mark Thursz asked whether these findings suggest that treatment guidelines should be revised to recommend treatment for immune-tolerant patients.
Gane replied that while the study shows that we certainly can treat such individuals, the question is who will benefit. "We need to show that long-term viral suppression in patients with normal ALT will prevent progression and HCC," he said.
Results
Viral load declined dramatically in both arms soon after starting treatment.
By week 192, significantly more people achieved undetectable HBV DNA (< 69 IU/mL) in the combination arm compared with the tenofovir monotherapy arm, 76% vs 55%, respectively.
About half the patients stopped treatment after 192 weeks, however, and their viral load returned to baseline levels.
Serological response rates were very low both arms.
6 tenofovir monotherapy recipients and 2 receiving the combination experienced HBeAg loss, and 5 and 0, respectively, had HBeAg seroconversion, but the differences did not reach statistical significance.
No patients in either arm experienced HBsAg loss or seroconversion.
In a univariate analysis, female sex, lower baseline HBsAg and HBV DNA levels, and use of combination therapy were associated with a greater likelihood of viral suppression.
In a multivariate analysis, female sex (odds ratio 6.0) and combination therapy (odds ratio 3.9) remained the only significant predictors.
Treatment was generally safe and well-tolerated.
6 people receiving tenofovir alone and 3 taking the combination regimen experienced adverse events, which generally were not considered related to study drugs.
No participants saw elevated creatinine levels or reduced creatinine clearance suggestive of kidney function impairment (a known tenofovir side effect).
No tenofovir resistance mutations were detected through 192 weeks.
"Prolonged antiviral therapy maintains potent viral suppression and is safe in immunotolerant patients," the researchers concluded. "The underlying impaired immune responses to HBV in this population may explain the poor serological response rates to antiviral therapy."
The treatment advantage for women in this study was stronger than the effect usually seen in trials of active chronic hepatitis, leading the investigators to suggest that, "Gender may be an effect modifier in treating chronic HBV patients with high viral loads and normal ALT values."
Session chair Mark Thursz asked whether these findings suggest that treatment guidelines should be revised to recommend treatment for immune-tolerant patients.
Gane replied that while the study shows that we certainly can treat such individuals, the question is who will benefit. "We need to show that long-term viral suppression in patients with normal ALT will prevent progression and HCC," he said.
Personally I am not aware of any studies that use Truvada on HBV patients, as it is FDA approved for HIV only.
Sorry, one mistake i did in posting.
I've mentioned HIB in original post. It's actually HBV - hepatitis B.
I've mentioned HIB in original post. It's actually HBV - hepatitis B.
Thanks for replying.
I'll have another appointment for Dr. Why not just use tenofovir? I've seen some online studies which suggest Truvada is more effective than Viread for HBV patitents? If this is justification, why FDA is not aware of this?
I'll have another appointment for Dr. Why not just use tenofovir? I've seen some online studies which suggest Truvada is more effective than Viread for HBV patitents? If this is justification, why FDA is not aware of this?
Good point. The preferred treatment for Tenofovir resistance is switch to or add Entecavir. However, the alternate treatment is switch to Truvada according to Prof Anna Lok).
Definitely change doctor, too difficult to be so ignorant, the most probable thing isnhe is corrupt to prescribe truvada against all guidelines and when it is totally useless and more toxic
guidelines are for tenofovir which is safe on pregnancy, you can keep it for many years since it is probable it will clear hbsag in about 17 years.to shorten that time you can add on peginterferon after 5 10years of tdf but i m sure there will be many other cures by 5 10 years
it is also possible to stop tdf safely anytime, you just need to combo with pegintf
guidelines are for tenofovir which is safe on pregnancy, you can keep it for many years since it is probable it will clear hbsag in about 17 years.to shorten that time you can add on peginterferon after 5 10years of tdf but i m sure there will be many other cures by 5 10 years
it is also possible to stop tdf safely anytime, you just need to combo with pegintf
Sorry but truvada is not ok in case of tdf resistance , which is only theory because there is notone single case of naive treatment developping resistance.the other antiviral in combo is too weak and similar to lamivudine, it also shares lamivudine mutants and resistance
the correct choice is entecavir which combo with tdf cross protect from development of any resistance
i think there are many tries from drug makers to push truvada because the patent will expire after many years.tdf should expire in few years
the correct choice is entecavir which combo with tdf cross protect from development of any resistance
i think there are many tries from drug makers to push truvada because the patent will expire after many years.tdf should expire in few years
There are no reported cases of drug resistance to Tenofovir. If there were, Truvada is the recommendated treatment.
" it is recommended for HBV patients who develop resistance to Tenofovir. "
i thought tenofovir didn't show any resistance, are there any other statistics ?
i thought tenofovir didn't show any resistance, are there any other statistics ?
You are correct that Truvada is a combination of tenofovir and emtricitabine, and is generally prescribed for patients with HIV. Being a HBV forum, most of us know very little about Truvada except that it is prescribed off-label for HBV by some doctors, and that it is recommended for HBV patients who develop resistance to Tenofovir.
So I cannot answer all your questions, especially about the safety of Truvada during pregnancy, however I am sure you can find more information on that topics, especially from experiences of HIV mothers. Many recent studies have indicated that Tenofovir (Viread) is safe throughout pregnancy and even suitable during breastfeeding.
Doctors generally advise treatment during the third trimester for pregnant women who are HBeAg positive and with very high viral load, as you say, to further reduce the risk of vertical transmission in addition to HBIG and HBV vaccination within the first twelve hours after birth.
For HBeAg positive patients, treatment can generally stop after HBeAg becomes negative and a suitable period of consolidation. Personally, I think there will be a cure for HBV within the next 10 years, so the notion of lifetime treatment for younger patients is too pessimistic.
Treatment for patients in the immune tolerance phase is generally not recommended, as the liver is minimally damaged. But whether you are still in the immune tolerance phase is not determined by your age, but by your levels of ALT and the state of your liver can be determined by a Fibroscan.
Just my opinions.
So I cannot answer all your questions, especially about the safety of Truvada during pregnancy, however I am sure you can find more information on that topics, especially from experiences of HIV mothers. Many recent studies have indicated that Tenofovir (Viread) is safe throughout pregnancy and even suitable during breastfeeding.
Doctors generally advise treatment during the third trimester for pregnant women who are HBeAg positive and with very high viral load, as you say, to further reduce the risk of vertical transmission in addition to HBIG and HBV vaccination within the first twelve hours after birth.
For HBeAg positive patients, treatment can generally stop after HBeAg becomes negative and a suitable period of consolidation. Personally, I think there will be a cure for HBV within the next 10 years, so the notion of lifetime treatment for younger patients is too pessimistic.
Treatment for patients in the immune tolerance phase is generally not recommended, as the liver is minimally damaged. But whether you are still in the immune tolerance phase is not determined by your age, but by your levels of ALT and the state of your liver can be determined by a Fibroscan.
Just my opinions.
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