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Need your advice please
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Need your advice please

Hello everyone.
I'm new in this forum, and found it during my search to learn more on HBV relating to my condition.
First, I would like to thank you to all that took time to write on this forum to help other people.

Sorry for a long post, but I want to convey the complete history and info for your examination.

My info and background:
I'm a 50 yr old South East Asian male.  I think I got HBV since birth (vertical transmission).  My father died from liver cancer related to HBV when he was 50 yr old.  He was in the service and was smoking and drinking heavily.  Two years ago, my cousin, who was 30, also die from HBV.  
I'm 5'6, 142Lbs, and in relatively good shape.  I exercise regularly with weight training, about 20-30Km run each week.  My wonderful wife makes sure that I eat lot of vegies and fish.  I travel a lot (for work and play) and do cross country hiking and down hill skiing.

My condition:
My test results from 2 Apr 2009

Hep B Surface Antigen   Positive
Hep Be Antibody            Positive
HBsAG                           Quantity of serum sample not sufficient
HBV DNS, PCR QUANT (c)      H 14737  IU/ML
HBV DNA, VIRAL LOG (c)        H  4.168   LOG IU/ML
ALFA-FETO.   TUMOR MARKER(c)    3.2  NG/ML      (0-15)
PSA, TOTAL                                        0.73  ng/ml      (0.00-4.0)

My test results from 11 Aug 2010

HBsAG                           Confirmed
HBV DNS, PCR QUANT (c)      H 213347  IU/ML
HBV DNA, VIRAL LOG (c)        H  5.1329   LOG IU/ML
ALFA-FETO.   TUMOR MARKER(c)    3.5  NG/ML      (0-15)
PSA, TOTAL                                        0.54  ng/ml      (0.00-4.0)

My test results from 20 Sep 2010

HBV, PCR QUANT (c)      H 813,090  IU/ML
HBV as COPIES/mL          H  4,732,200   Copies/ML
HCV Ab                      not infected

Diagnoistics:
My family doctor and HepB Specialist prescribed VIREAD for me to take immediately.

My action:
I'm still hesitate to take VIREAD since:  1- It will be a life-time medicine and 2 - My HBV may develop resistance to it.  So I asked for another blood test to be sure and to test for GENOME TYPE since my doctors had never tested this.  I am also thinking of getting a second opinion from another Hepamathologist before feeling sure to take VIREAD.

My question:
1.  Should I take VIREAD immediately as suggested by my primary care doctor?  And why?
2.  Will VIREAD change my life style, i.e. make me exercise less, no more hiking / skiing trip?
3.  Am I correct that I will take VIREAD for life?
4.  When will VIREAD develop resistance?  Any known data / study on this?
5.  What is the life expectancy can I expect?

Thank you again for sharing your information.
God Bless.

Sigma9
Related Discussions
11 Comments Post a Comment
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Avatar_m_tn
First of all, I am new to hbv too.

According to my doctor, your viral load is relatively high. And it is persistently high. What are your AST/ALT? My doctor said >40 yr old and asian male make things more concerned. And you have family history of liver problem. In my case (42 yr old), my viral load is ~6800 iu/ml, AST/ALT are 22/32. No family history of liver cancer. A liver biopsy was ordered immediately. I am ready to go treatment with anti-virals. So maybe you want to do a liver biopsy as the first thing.
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Avatar_m_tn
1.  Should I take VIREAD immediately as suggested by my primary care doctor?  And why?

--This is a personal question depending on your point of view.  Your doctor is giving you the standard 2007 guideline recommendation and he is safe.  There is a view that chronic diseases like HBV are not treated well by Western medicine yet even though they are superior at emergency, surgery, vaccination and diagnosis.  This view is very critical of the antiviral approach that is toxic to the liver at the same time it is controlling the replication of HBVDNA.

2.  Will VIREAD change my life style, i.e. make me exercise less, no more hiking / skiing trip?

--Initially, probably not.  If after years of taking it with its toxicity your weakens, then there may be changes.

3.  Am I correct that I will take VIREAD for life?

--Mostly likely, but there are individual variations.

4.  When will VIREAD develop resistance?  Any known data / study on this?

--It is not Viread developing resistence, it is your HBV developing resistence to the antiviral.  Google under Tenofovir.

5.  What is the life expectancy can I expect?

--Depends on how your liver is cared for.

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Avatar_m_tn
Thanks for your answers and comment CaJim.

My Hep Specialist did not think a liver biopsy is necessary.  He reason was that I need to take VIREAD right away due to a clear indication from above results.  So my question is:  In my case, is liver biopsy a necessity?  What information / benefit does it provide VS. the risk associated with this procedure?

It seems clear to me now that I need to start taking VIREAD due to elevated viral load count.  
My AST/ALT from April 09 was 29/30
And from Aug 2010 is 68/32
What is this mean?

Thanks.
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Avatar_m_tn

1.  Should I take VIREAD immediately as suggested by my primary care doctor?  And why?
to prevent liver cancer and cirrhosis, with your viral load there is one thing certain if it doesn t decrease liver cancer or cirrhosis will arrive, and when they do there is nothing almost nothing to do except for eraly cirrhosis which can be reveresed
the only mistake your doctor did is no biopsy or fibroscan to see how much damage your liver has

2.  Will VIREAD change my life style, i.e. make me exercise less, no more hiking / skiing trip?
no but the amount of your liver damage will if you dont lower hbvdna

4.  When will VIREAD develop resistance?  Any known data / study on this?
viread has no resistance, it is not even known if a mutant with viread resistance exsist since none have been detected until now, data is from hbv-hiv coinfection about 12 years and from hbv infection 4 years.there is only one case of mutant detected on hiv-hbv coinfection but since there is also immune system not working it is not possible to say if it lowers viread response.On viread exists only in vitro data not confirmed in vivo about a decreased response on adv reistant mutants.
after suppression of hbvdna for about 10-15years there will be almost no cccdna left in your liver, so if hbv replication remains suppressed for so long time you will get rid of virus.the drugs to eradicate hbv are ready they will be probably on the market in 2017 wen viread and baraclude patent expires.i dont think it is a good choise to keep damaging the liver

3.  Am I correct that I will take VIREAD for life?
probably 15-20 years, but i think that this time will be reduced by immune modulators combo of tenofovir+nitazoxanide or interferon, there is already much data on this and trials results should have already been published, i don t know why they didn t


5.  What is the life expectancy can I expect?
if you suppressed hbv replication you will dye of other causes, if not we already know cirrhosis and liver cancer risk

viread sides
on less than 1% kidney function and bone mineral density, if you check both while on treatment you can avoid both since if you fall under that 1% you can lower drug dose or switch to entecavir
liver damage makes also low vitamin D on more than 95% hbv carriers and vitamin D deficency makes low bone mineral density and osteoporosis which is very common on hbv carriers with liver damage after 40-50years old

my suggestion is do not wait for severe damage and since in US you dont even have fibroscan to monitor liver damage every 6months/year i'd start viread or make whatever possible to find one.in case you find you have no liver damage you can wait for our nitazoxanide results or for other drugs that can eradicate hbv but if you have more than f2 damage on biopsy or 7kpa on fibroscan it is stupid to let the liver damaged more

there has beeen a lot of mess in 2000-2005 hbv antivirals and it was already knew by drug makers that virad was the only drug potent enough to prevent resistance for hbv, but using lam and adv drug makers could make more money....

also if genome test finds no mutants resistant to drugs in >5% of your hbv population you can start entecavir which has no sides at all
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Avatar_m_tn
My Hep Specialist did not think a liver biopsy is necessary.  He reason was that I need to take VIREAD right away due to a clear indication from above results.  So my question is:  In my case, is liver biopsy a necessity?

--Compare a bone fracture X-ray evaluation with your liver biopsy evaluation.  The former can tell if there is facture which has impact on treatment or not.  If your doctor will have you start on Viread regardless of the result from liver biopsy, then I agree that liver biopsy is unnecessary in your case.  In my case, liver biopsy result determined if I went on antivirals or not.  It made a difference, so for me it was necessary.

What information / benefit does it provide VS. the risk associated with this procedure?

--Low risk, little pain, but no benefit in your case.

It seems clear to me now that I need to start taking VIREAD due to elevated viral load count.   My AST/ALT from April 09 was 29/30 . And from Aug 2010 is 68/32.  What is this mean?

--ALT 29 to 68 alone cannot determine if your liver has worsened or not.
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Avatar_m_tn
Thank you, Cajim & stefano170669, for your answers and comments.

From your information, I feel more knowledgeable and understand my situation better.  This gives me hope and confident to decide what needs to be done next.

I'll keep posting my progress FYI.

BTW - Anyone knows a knowledge and reputable Hep Specialist in the Northern Virginia / DC area?

Thanks.
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Avatar_m_tn
Last Fri I went to meet with my Specialist and found that my viral count went from 4M to 16M in 3 weeks period.  I started taking Viread that night.

Sat morning I went for a 10K run, everything seemed to be normal.

Sun I did some yard work, went to see my daughter at her college.  Everything seems to be fine so far.

With some time to think and reflect, I know that here in the USA, I have the medicine and access to the best medical facility.  I also have a wife that will be here for me no matter what.  I came to accept the situation and thankful for what I have.  I will live everyday to the fullest, take good care of my health, and let it be!

I think I will start a new thread for people taking Viread to share experience and info.

Take care everyone and ... smile :)
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Avatar_m_tn
Viread should knock viral count to UND.  Do not do extreme exercise.  Live liver-friendly, that can help.  Best wishes.
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Avatar_m_tn
Thanks for the advice, but I've been doing 10K run twice or three times for the last 15 years.  So is it still considered to be extreme exercise?
Thanks.
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Avatar_m_tn
You know best.  If you feel exhausted after running, then maybe it is not good for your liver.
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Avatar_m_tn
Roger that!
You know your body best and I always listen to my body and act accordingly!
Thanks cajim.
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