Should I switch to ent + tdf combo

[cyrus131]

I have been on 0.5mg entecavir for about six years and my viral load is still detectable at some 180 copies/ml.  My ALT has been normal.  I am just afraid that I already have entecavir resistance mutations rendering a higher HCC risk.  Any help is greatly appreciated.  Thanks a lot.

[stef2011]

So should I insist etv + tdf combo when I see him next time?  

yes but the combo is just to safely discontinue etv and switch to tdf, to do this safely a combo of 6months of both is needed

whether I should use interferon and he estimated that my chance of success is low (I am still e-antigen +ve)

how can he say low chances?does he know hbsag quant?being hbe+ is an indication for intf since when hbe- your chances will be even less.remember better schedule is 3 years of tdf and then intf add on

[cyrus131]

Dear Stefano,

So should I insist etv + tdf combo when I see him next time?  Btw, I also asked whether I should use interferon and he estimated that my chance of success is low (I am still e-antigen +ve).  Any views about the use of interferon on my case?

Regards,

Cyrus

[stef2011]

My doctor claimed increasing the dosage will have 10 times higher antiviral power.

your doctor lied to sell entecavir which is the most expensive drug now on hbv or he is so ingnorant to tell patients the first fantasy that comes to his mind

[cyrus131]

Dear Stefano,

Thanks for your prompt and expert advice.  My doctor claimed increasing the dosage will have 10 times higher antiviral power.  Btw, I don't think he would have any connection with drugs sales.

Regards,

Cyrus

[stef2011]

etv 0.5mg or 1mg are the same potency, the 1mg dose was thought to be more potent on resistance development only

if etv 0.5mg doesn t work it is useless to increase dose, in my case researchers added tdf for hbvdna being between 10-15iu/ml, i asked them for etv 1mg and they said you just increase possible sides with no effect

why to stay with etv if tdf is more potent, free of resistance and cheaper?ask this to your doctor and double check if he has any connections with etv sales (possible hidden drug makers benefits vs sales).

if you add etv+tdf you can stop etv after 6months on the combo if hbvdna und

[cyrus131]

Dear Stefano,

I met my doctor today and he suggested me to increase the dosage of entecavir from 0.5mg to 1 mg though he was of the view that such change may further reduce the viral load but just not cost-effective.  He said this treatment is better than etc+tdf combo in that I should be no problem of sides after increasing the dose and I still have tdf as a backup in case of need.  Any advice from you is very much appreciated.  Many thanks.

Regards,

Cyrus

[cyrus131]

Dear Stefano,

       Thanks but I have been on entecavir for about six years, do you think I have developed etv resistance?  My hbvdna is below < 200 copies / ml since 2009.

[stef2011]

etv and tdf work on hbvdna only so you just need hbvdna to be und by 48weeks maxiumum or possibly by 3 months, after 48weeks they might work with no resistance or go to develop resistance

[cyrus131]

Dear Stefano,

    Your comments on other post "hbvdna und makes no difference if the hbsag has mutated to forms cytopatic, liver will be damaged anyway with hbvdna und, ast/alt normal".

     How do I know if my HBV has mutated to from cytopatic?  I am a bit worried after reading all you guys comments.  Thanks a lot.

[cyrus131]

Dear Stefano,

         Thanks for your advice.  I have not done other tests except hbvdna.  Should I do other tests before I consider starting the combo?  Are there better alternatives?  I am still HBeAg +ve.  

[cyrus131]

I had detectable viral load at week 40 treatment at 38819 copies/ml (from 6.8 x 10^8 pre-treatment).