So I had a discussion with my doctor yesterday regarding the recent elevation in my AST, ALT ( about 1.5 x ULN). I am LAM resistance, on Truvada for almost 2 years now. Everything else (HBV DNA undetectable, ultrasound ok, CBC, fibroscan + all other stuff i have no idea) came back normal. AST + ALT was in normal range all the time but 3 months recently have been up a bit.
She advised me to continue monitoring my condition and warn me about possible resistance. I thought truvada (tenofovir) has no resistance up to now.
I asked her what I should do when I develop resistance to Truvada. She said she may ADD (or switch, I forgot exactly what she said) Baracude. This surprised me a bit because I thought Baraclude would not work on LAM resistance. Am I wrong?
yes you are right, etv will work but for a short time (about 50-70% resistance at 5 years), very bad solution
i suggest check hbvdna with ultrasensitive hbvdna and see if it increases, decreases again because truvada resistance is very unlikly although not impossible
you can check with this supersensitive assay
resistance is confirmed only by hbvdna elevations to detectable or increasing for 2 times between 12 and 50iu/ml, alt/ast elevations are not due to liver only but to many reasons even truvada toxicity to the liver
in case of resistance:
i'd add alinia immediately and see if hbvdna gets down again, if not i'd use interferon which s active on all hbv strains, after interferon for 1 year i'd switch again to truvada and maybe mutants are cleared
if alinia works it is better to wait until interferon lambda will be available, it has ony very mild sides so it can be used combo or for long times until hbsag negative
it is a different interferon from previous one and not marketed already, the researcher said it will take 5 years for use on hbv but will be available very soon for hcv so off label therapy will be possible
the bad is the old producer of interferon and entecavir bought the small company who discovered interferon lambda so they will slow down availability of interferon for hbv probably since it might damage entecavir market
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