Aa
Some advice please!
I am 21 years of age, male. I am a chronic carrier e antigen +, probably since birth, since June 06, my viral HBV count was 169 million copies/ml
The doctor had put me on telbivudine (tyzeka) since then. The medication was quite effective during the first year bringing it down about 20,000, however, not effective enough to bring it to UND levels. Up until now (may 09), the viral count does not seem to be going down much further but seems to be lingering around 4log copies(20000-40000). The drug seems to have build resistance and the Dr. seems think I will be on this medication for life which does not appeal much. Would switching to another anti-viral be a good idea? I've the opinion that viread may be the best option in this case with tyzeka resistance.
I plan to go abroad for the summer by an accepted internship and my health insurance will not cover dispensing the drug for more than 1 months supply. It is against customs to ship prescription overseas. I cannot afford to pay the whole price. would it be a very bad idea to stop the prescription?
Many journals i have read will talk about a relapse and a serious worsening of hepatitis upon premature ending of the prescription. Although I found it hard to find what accompanies this relapse. What constitutes this relapse? Is it just a spike in viral amount back to pre-treatment times, but asymptomatic? Or will it be very symptomatic leading to direct and immediate liver complications?
I am quite confused as to what to do, part of me regrets making the medication at such a hectic age in life. But hey I need to figure something out.
thanks for reading.
The doctor had put me on telbivudine (tyzeka) since then. The medication was quite effective during the first year bringing it down about 20,000, however, not effective enough to bring it to UND levels. Up until now (may 09), the viral count does not seem to be going down much further but seems to be lingering around 4log copies(20000-40000). The drug seems to have build resistance and the Dr. seems think I will be on this medication for life which does not appeal much. Would switching to another anti-viral be a good idea? I've the opinion that viread may be the best option in this case with tyzeka resistance.
I plan to go abroad for the summer by an accepted internship and my health insurance will not cover dispensing the drug for more than 1 months supply. It is against customs to ship prescription overseas. I cannot afford to pay the whole price. would it be a very bad idea to stop the prescription?
Many journals i have read will talk about a relapse and a serious worsening of hepatitis upon premature ending of the prescription. Although I found it hard to find what accompanies this relapse. What constitutes this relapse? Is it just a spike in viral amount back to pre-treatment times, but asymptomatic? Or will it be very symptomatic leading to direct and immediate liver complications?
I am quite confused as to what to do, part of me regrets making the medication at such a hectic age in life. But hey I need to figure something out.
thanks for reading.
What justification did your doctor give you to treat?
Why did your doctor choose Telbivudine to begain with?
Is your treating doctor very familiar with HBV?
These are important questions to clarify. On the surface, the way treatment is going is not good. Telbivudine has a poor resistance profile. It's similair to Lamivudine, which is 30% risk for resistance at year one. And it resistance goes up with time, especially if your HBV DNA is still in detectable range. If resistance develops, your treatment choice takes a hit. But you shouldn't stop taking your meds because your DNA will likely go back up to very high number and this again will put you at greater risk for resistance. Since you have limited response, you may want to ask your doctor for add-on treatment, that is adding another antiviral, like Tenofovir or even Adefovir. If you continue to treat you need to reach UND status. Or if you could only do mono-treatment, you may want to ask your doctor to consider adding Tenofovir and once you reach UND, stay combo for a couple of more months, then let go of Telbivudine and just do Tenofovir and hope it stays UND. But in these situations, once you start treating, you should really try to come off meds only after your eAntigen becomes negative and your eAntibody becomes positive. So make sure you have a good talk with your doctor.
Sorry for the nutshell answer but I think you need some info on this. Good luck...I'm be away. I'm sure the other regs will give you good feedback.
Why did your doctor choose Telbivudine to begain with?
Is your treating doctor very familiar with HBV?
These are important questions to clarify. On the surface, the way treatment is going is not good. Telbivudine has a poor resistance profile. It's similair to Lamivudine, which is 30% risk for resistance at year one. And it resistance goes up with time, especially if your HBV DNA is still in detectable range. If resistance develops, your treatment choice takes a hit. But you shouldn't stop taking your meds because your DNA will likely go back up to very high number and this again will put you at greater risk for resistance. Since you have limited response, you may want to ask your doctor for add-on treatment, that is adding another antiviral, like Tenofovir or even Adefovir. If you continue to treat you need to reach UND status. Or if you could only do mono-treatment, you may want to ask your doctor to consider adding Tenofovir and once you reach UND, stay combo for a couple of more months, then let go of Telbivudine and just do Tenofovir and hope it stays UND. But in these situations, once you start treating, you should really try to come off meds only after your eAntigen becomes negative and your eAntibody becomes positive. So make sure you have a good talk with your doctor.
Sorry for the nutshell answer but I think you need some info on this. Good luck...I'm be away. I'm sure the other regs will give you good feedback.
At the beginning of treatment my ALT level was slightly above normal about 40s if i recall,
during treatment it went up to about 67 once, Most recently (march) it was about 35.
during relapse, will there be symptoms such as jaundice and other liver symptoms?
I figure that If I were to go off the medication (it does not seem to be leading me to UND anyway) HBV count may spike, but I would get periodic checks and if it get very bad I can go on re-treatment to control it. Otherwise, I would just keep waiting until I am older and can focus better on the disease. I am optimistic of treatment in the future, but am worried what to do now, I've made an appointment to meet with my doctor next week.
Thanks for reading.
during treatment it went up to about 67 once, Most recently (march) it was about 35.
during relapse, will there be symptoms such as jaundice and other liver symptoms?
I figure that If I were to go off the medication (it does not seem to be leading me to UND anyway) HBV count may spike, but I would get periodic checks and if it get very bad I can go on re-treatment to control it. Otherwise, I would just keep waiting until I am older and can focus better on the disease. I am optimistic of treatment in the future, but am worried what to do now, I've made an appointment to meet with my doctor next week.
Thanks for reading.
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