Some Light On New Lab Results Please.

Can you guys please share some lights on this current Lab results for me? I was told to come and discuss my result and I met a doc

[jboyhk]

Only think I can say is that Tyzeka is the latest HBV drug on the mkt so at least ur dr is up to date. It is supposed to be more effective. I would go with their advice.

[jboyhk]

Is Tenofovir approved for HBV?

According to this chart
http://www.hivandhepatitis.com/hep_b/treatment_chart.html

its in Stage III trials.

[Hepatitis Researcher]

As I suspected and told you in the past, it seems Hepsera does not have enough antiviral power for you. If you play too much with the antivirals you might breed resistance.
I would use Baraclude combined with Tenofovir to get the virus down quickly to undetectable levels, then you can think about how to maintain it, unless you seroconvert the e-antigen.

Are you working out? you have mildly elevated muscle enzymes (CPK and Aldolase)

[Hepatitis Researcher]

Tenofovir is not approved for HBV at this point in time. But it will be soon.  A phase III trial is ongoing. But the insider already knows that it is the most promising HBV antiviral and it is used for HIV since 2002. I have worked with the development of literally of all this HBV antivirals since 1994 and know the very finest details of their toxicity, resistance profile, resistance propensity, possibility to combine, late effects of being resistant to one of them on ability and outlook to use "rescue" HBV antivirals. Also what is further out on the horizon.Not much!! No mistake must be made, unless you want to gamble and hope for your T cell response to take over. There is only a very small chance to seroconvert the S antigen. Most will NEVER ACHIEVE THAT, there is almost no SVR like with HCV. Until then, the VL needs to stay long long long term UND. Often for life. Resistance is the biggest problem. If somebody wants to be still ok 10/20 years later it is awfully important to prevent resistance from ever creeping up. Primary YMDD resistance predisposes you to much faster resistance even from the "YMDD effective " antivirals. Treatment has never been as perplexing to the practitioner ( because of the bewildering multitude of antivirals)  as now and life/fate  deciding mistakes are made by the thousands. This is often a one way road, these mistakes cannot be forgiven, once a new untreatable HBV variant has taken hold, the hepatitis will often progress relentlessly.  

[mremeet]

Sounds like HR is basically trying to save (or extend) your life. Do you understand the significance of what he's telling you? I'd seriously rethink taking that drug as a monotherapy, if it's not already too late. Looks like you have a limited window of opportunity to do this right. And it also sounds like your doctor (who's apparently ill informed) may very well be squandering your chances as we speak. Once that window closes, you could be out in the cold for good.

[Anthony K]

Sorry guys for getting back on the topic late. I just returned from a day trip.

Hep Researcher: I've been working out and play basketball whenever I could. So does weight training causes CPK and Aldolase to elavate? If so, is there anyway to be sure the elavation is not caused by any other thing?
I've started taking Telbivudine last night. Since the combination of the Hepsera and Telbivudine is causing me all kinds of problems, the doc asked me to stop the Hepsera and go solo on the Tyzeka.

Q. Are you saying stopping Hepsera and staying on Tyzeka alon could cause resistant? I'm also pondering about taking the Hepsera in the morning and the tyzeka at night cus the doc said taking them in the same time frame could be the reason why I experience those sysmptons.

[Hepatitis Researcher]

I am quite a fan of Telbivuine, but it is in essence a much stronger Lamivudine and unless you drop VL very rapidly on it it will also lead eventually to the YMDD resistance mutation , like Lamivudine.Then you are in some trouble.
Hepsera is a weak antiviral because its dose had to be reduced way below its maximum efficacy ( about 100mg) to a lousy 10mg because of its kidney toxicity. So about a quarter of patients do not or only weakly respond to it, like you. the average VL reduction after one year of treatment was only 3.6 logs, with a wide variety between patients (low consistency of effect). Gilead will however soon bring out the new power drug against HBV - Tenofovir -that can be given at 300mg/day with almost no kidney toxicity.
Still, even with tenofovir, if you want long term no resistance, a combo is most likely advisable. This will be presented at the 2012 AASLD meeting.

[Anthony K]

Thanks Hepresearcher. I have some questions regarding this subject but I'm running late for work and I'll post my question to you when I return.
Thank you guys again for your support.

[Anthony K]

Q. Is there an increase chance of YMDD resistance switching from on antiviral (Hepsera) to another (tyzeka) back and forth in a short period of time? I started on adefovir and the new doc started me on telbivudine. I had to stop telbivudine cus of adverse effects I was experiencing on the combo. Now the doc said to resume taking telbivudine again and cease taking hepsera so that's what I'm doing. Will this back and forth between meds increase any chance of resistance?

Q. Would combining adefovir with telbivudine, which I'm taking now in different time frames; morning and night, give me a greater chance of attaining undetectable VL?

Last Q. Since Telbivudine is quiet new in the market, any clue on how long before one develops resistance? And is developing resistance to resistance to one antiviral prevent you from using others?
Thank You. Tony.

[Hepatitis Researcher]

The combo hepsera plus telbivudine is certainly better than just one of them. But you dont respond well to hepsera, which can prevent  the YMDD mutant that you can develop when using Telbivudine for a long time. The first year resistance to telbivudine was around 6%, the second year is a bit unclear, but probably around 16%. It also depends how fast the response to LdT (telbivudine) is. Very rapid response to UND below 100 copies - within 24 weeks will delay or even prevent resistance of the YMDD kind. Switching back and forth is not good. As I said you need to get the VL down fast, treating against a high viral load for longer times gives the virus a proportionally better chance to come up with primary and secondary, compensatory mutations.

As to the other question, see above:
" Primary YMDD resistance predisposes you to much faster resistance even from the "YMDD effective " antivirals"
so that presence of YMDD predisposes you to Entecavir/Baraclude resistance and even Adefovir resistance. In the end you can be multiple resistant to all the HBV antivirals. This might take a long time or might never come, but the chances are very real and then there is nothing that can be done anymore, but hope for a transplant. A liver transplant however gets reinfected typically from the start once there is multiresistance, albeit Hepatitis B Immune Globulin can curb it in many patients ( For about 50000.00$ a year) but not in all. Tenofovir helps then still, but we dont know how long that drug alone can hold against resistance.
Early wisdom in treatment is the key to long term success.

[Anthony K]

Thank You Hep Resercher. I really appreciate your comment. I'll add hepsera to the telbivudine at different time frames and hope for undetectable VL.
My next lab work is 2 months away and these are some of the test requested.
Aldolase, CBC, Comprehensive Met Panel, CPK, HBV-DNA, Prothrombin Time and LDH.
One more Question. What does it mean if Aldolase is High? 9.6 in a range  of 1.2-7.6? Should I be concern? and What about the Creatine kinase? 287 in a range of 24-204
Any steps needed to be taken?
Thanks.

[Hepatitis Researcher]

Aldolase and CPK are both enzymes that indicate with good specificity muuscular damage, as incurred in intense exercise and some pathological conditions. Yours are only very mildly elevated, as expected when somebody works out, in particular if there exists additionally a proinflammatory state as in chronic hepatitis.

Did you use Tyzeka in the 2 weeks before the last blooddraw or not? One of its side effects, in about 10% was elevation of CPK, by a mechanism not understood.