My doc told me I can take viread on my third trimester

[Aimee2050]

Ok my doc called me back told me my viral load is high as in billions, and my ultrasound came back normal for my liver. He said normally they won't treat patients in my case(chronic hep b carrier active), but since i'm pregnant he suggest that I get treatment, if not it might transfer to the baby too even if the baby have the shots. His other suggestion is that I don't have to get treat it and closely monitor after having the baby so I'm taking a chance on the baby. He told me if i decided to get treatment I will have to take Viread, anyone know or took this and what side effect are there? Is this safe for pregnant women? I just want other opinion on this. I will pick up the report on tuesday and maybe get another opinion.
Once I start Viread I can't stop, I don't know  how much or how long I have to take this i'm just worry.

[Thitmd]

I have the same situation as you, and I am thinking should i take the viread. What is your desicion finally? How is your baby? Can you stop taking viread?

[stef2011]

http://archive.mail-list.com/hbv_research/mindex/hbv_research***@****
(digit pregnancy in the search box at the bottom of screen, many info)


http://www.hepb.org/patients/pregnant_women.htm

http://archive.mail-list.com/hbv_research/message/20100206.104225.8517d770.en.html

there is some data on safety of antivirals but not on immune tollerant, ask other specialists about imm.globulins results and risks of viread on immune tollerant

[Aimee2050]

Thank you so much for the reply, i'm going to check with another GI doc this coming tues. I'm having a hard time finding a doc that's up to date with hep b. There are many liver docs/hepatology, but just can't tell if they are up to date or not. I def want to see two more doc and see what they say. Thank you for all the info i'll def keep you updated

[stef2011]

do check another doctor, you are immune tollerant and immune tollerance phase cannot be treated in anyway and must not be treated because there is no therapy that can lower hbvdna without immune response

antivirals as i told you before can make dangerous virus mutations and guidelines say clearly you must not be treated and after all you don't need treatment because perfectly healthy, the liver damage is not made by virus but by immune system.
on the other hand such high hbvdna makes possibility of baby infection higher but using antivirals is too risky for both of you and possibility to lower hbvdna is almost zero

check with a very good liver specialist and who is uptodate on hbv, i think i read somehwere that they tried immune globulins to lower possibility of baby infection

there is an asian guy who posted on the forum and he was not immune tollerant (alt were abnormal) but very high hbvdna, he tried a combo of the most potent antivirals baraclude and viread to lower it and even with his immune response he couldn't lower it to zero and maybe he did by 1 years therapy, this just to give you an idea of how viread is useless with high hbvdna and much more on immune tollerant

http://www.medhelp.org/posts/Hepatitis-B/Combo-Treatment-Baraclude--Viread-results/show/938200

[enolia]

Hi Aimee

As Stefano mentioned, I believe you are immune tolerant with very high viral load but still normal ALT (liver function). Not sure if you should start Antiviral even though Viread hasn't shown any resistance generally, I don't know about the immune toleance phase. Because you are pregnant and  have millions DNA, I believe you should treat at the 3rd trimester. See this reference on how to manage the immune tolerance phase...It is hard, because, you would also be committing to years of treatment...You should discuss the risks with your specialist. good luck!

[Aimee2050]

hepatitis b virus dna >110,000,000 H 640,200,000 H <169 copies/ml

[Aimee2050]

ok i just went to picked up my report

AST 18
ALT 16

Hepatitis B virus DNA, PCR
Hepatitis B virus DNA >110,000,000 H 640,200,000 H<169 copies/ML

Genotype B
polymerase mutations not detected
precore mutation not detected
bcp mutations not detected

abdomen ultrasound normal

What do you think? So how serious is this? Do I need treatment? Tho doc told me in billions, but how come in millions? Should i still do the liver biopsy? If i do is it safe for pregnant women?

Thanks in advance

[cajim]

I know I'm in a pretty serious situation, I don't know what this will lead to other than very high possibility developing cirrhosis.

--Not necessarily.  You are HBeAg+ with normal liver function.  HBVDNA is expected to be high which does not mean you have liver damage at all.  Many people with your status change to HBeAg- with very low HBVDNA with no symptoms at all (so called healthy carriers) and live their lives like non-HBV people.

Can hep b turned into hep c?

--No.

If I take Viread is it possible maybe one day my HBEAG will become inactive?

--No.

I read online that you can transmit thru body fluid does that mean sweats?

--Yes but very low probability.

[stef2011]

If I take Viread is it possible maybe one day my HBEAG will become inactive?yes but once you start viread you cannot stop safely unti hbsag gets negative

i mean if you are inactive carrier you can get results, being immune tollerant no results only danger for hbv mutation resistance

[stef2011]

when you are hbvdna in the millions saliva and body fluids can infect although rarely but being immune tollerant is a good situation, you have no liver damage and no risk for cancer

Can hep b turned into hep c?
no

If I take Viread is it possible maybe one day my HBEAG will become inactive?yes but once you start viread you cannot stop safely unti hbsag gets negative

please check carefully by my suggestions and other doctors if you are immune tollerant or inactive carrier and whatever they suggest do not use antivirals if you are tollerant

[stef2011]

asians have b and c, they are both linked with super high viral load, less immune response, both linked to cancer but C more

but you have to be very carefull, see at least 3 liver specialist very updated by latest conferences because i see a big mistake of your doctor:
in this report i see alt 13, this means no immune response and no liver damage, you are immune tollerant not inactive carrier

to know for sure if you are immune tollerant or inactive carrier a biopsy is the best, if biopsy detected no liver damage or f1 liver damage you are immune tollerant

otherwise antigen quantification plus fibroscan and ultrasound can be of help:
in immune tollerant hbvdna, hbsag and hbeag are very high because there is noimmune response (hbvdna in the billions, hbsag from 10000 up, usually 50000)

if you are inactive carrier there is a strong immune response but in this case:
hbe cannot be positive, it must be like follows,
hbe negative and hbeab  negative
hbe negative, hbeab positive
hbvdna und or very low
hbsag lower than 2000iu/ml
alt/ast normal

why it is very important to know if you are immune tollerant, because there is nothing that can stop the virus if there is no immune reponse to help and using an antiviral can make resistance immediately so when you will start to have immune response and liver damage you will have no therapy to save you
the same for the baby  i wouldn't risk to infect the baby with a resistant virus

so in the end if you are imune tollerant there is a high risk to infect the baby but there is no way to lower hbvdna and if resistance happens it is very danagerous both for you and the baby

[Aimee2050]

Thank you all for replying, I don't have the most recent report yet, I have to pick it tomorrow on Tues. When my GI doc told me that I have genotype B, he's kindda surprised b/c he thinks most asian have genotype C. I don't really understand genotype B or C, but he mentioned that if i'm C i will have a high chance of cancer. So what does B links to?

Stefano I only have the following test result from a month ago.

ASL -16
ALT 13

HBSAG - reactive
HB core AB total - reactive
HB core AB(IGM) - non reactive
hepatitis B surface AB,QL- non reactive
HBEAG - reactive
HBEAB - nonreactive

I know I'm in a pretty serious situation, I don't know what this will lead to other than very high possibility developing cirrhosis. Can hep b turned into hep c? If I take Viread is it possible maybe one day my HBEAG will become inactive? I read online that you can transmit thru body fluid does that mean sweats?

[stef2011]

the problems are hbvdna in the billions, in this situation 10% babys get the virus despite vaccine

if you have to start an antiviral tenofovir (viread) is the best since it has no resistance detected so the safest among antivirals, actually the doctor made right choice since hbvdna in the billions needs most potent antiviral and viread may be potent enough if not they will add another antiviral combo

you are probably hbe positive, do you also have hbsag quantity iu/ml, hbvdna iu/ml, hbe quantity any unit, alt/ast, genotype?
hbe positive, hbsg very high, genotype a,b, d have probability to seroconvert hbsag, although very low and then stop therapy, this might happen in 5-10years

as to pregnancy it is the safest because used since 2000 on hiv so many women have had pregnancy while on tenofovir, the other drugs entecavir too new and all the others make resistance and not on giudelines any more

[enolia]

I understand how you feel...I feel the same right now and would like to stop Viread  especially that I haven't been told that I can not stop it after...I hate taking this pill every morning knowing that there might be risks for baby inside...I have hope that after delivery I will treat with Viread + Alinia and stop both of them. Alinia seems to be giving more fast results and seroconversion on HBV. Yes, you can not stop Viread (Tenofovir) because there are risks of flares. Good luck,

[cajim]

One views says as long as your liver function is normal and you take the normal precautions, your chance of passing HBV to your baby is very low whether you are HBeAg- or HBeAg+.  On the other hand, about 10 years data seem to indicate mothers taking LAM during pregnancy did not result in abnormal babies.  Viread is too new to have enough data.