Tenofovir resistance

[nihi120]

Hi All,
My HbeAg is reactive and Anti Hbe is non reactive, Quant HbsAg value varies between 30K-50K from starting. Rest LFT is normal & HBVDNA is not detectable, Fiboscan is normal. initially i went through PegIntreforen+ Tenofovir for 40 weeks in 2012 then i switch to only Tenofovir. Now it 3 yrs and 4 month on Tenofovir.

Last week my doctor told that you HbeAg should be non reactive after 2 yrs of Tenofovir but since it over 3 years so might be Tenofovir resistance So you need to change my medicine.

Please suggest me what i do.  

[nihi120]

Thanks Stef and all for valuable suggestions. I will discuss all of you suggestion with my doctor and then I will take decision. Thank you.

[stef2011]

just keep monitoring and when hbsag is low enough add pegintf, adding nucs is likly not to change anything because hbeag loss is due to immune system.....it will happen just keep tdf 5-6years

[stef2011]

not a doctor, maybe a witch???

only resistance test can confirm resistance to an antiviral and tenofovir does not have any resistance even if hbvdna remains detectable...hbeag with the knowledge we have today is of minimal importance, you must only monitor hbsag quant in iu/ml and hbvdna to stay und

[sorte]

"It is still unknown how nucs cut hbsag on long term treatment."

nucs restore partially T-cell response, page 25:

http://www.aphc.info/wp-content/uploads/2014/09/Carlo_FERRARI1.pdf

[Jatashankar]

But still immune tolerance will b a big hinderance and there is when we have no alternatives to fix hbv.

[Jatashankar]

Adding enticavir for a short time say 6months may reduce hbsag level and let the immune to work and convert e ag. It is still unknown how nucs cut hbsag on long term treatment. Y not give a trial. And yes u r right here this person is not resistant to tdf.

[StephenCastlecrag]

I cannot give you a scientific explanation why interferon does not work in the Immune Tolerance phase because there seems to be a new evaluation of the state of the immune system during the IT phase. However there are plenty of clinical studies that showed interferon is not effective during IT phase. It would be more effective during the immune clearance phase.
A high serum level of hbsag during the IT phase is an indicator of no or minimal fibrosis, in fact, one researcher suggested it may have a protective effect.
By treating with TDF in the IT phase, you may have altered the course of natural history of HBV, so in this context, a key characteristic of IT - very high viral loaf - is no longer true.

[sorte]

just curious, why peginf is not good in immune tolerant phase ? Because immune system "tolerates" the virust at least partially ?
How finally he can recognize he's not in immune tolerant phase anymore if hbv dna is und all the time ?

[StephenCastlecrag]

His hbvdna is undectable already! What will adding ETV achieve? Interferon is one drug that may help to achieve e-seroconversion, but very unlikely when given during the Immune Tolerance phase.

[StephenCastlecrag]

I disagree with your doctor. It seems you started treatment when you are in the Immune Tolerance phase (you should ask your doctor why he started treatment). The role of Tenofovir is to inhibit virus replication and it has done its job successfully as shown by your hbvdna being undetectable. As long as your hbvdna is undetectable, Tenofovir is working and there is no drug resistance. It is really strange for your doctor to say Tenofovir is not working because you have not e-seroconverted after two years. The real reason most likely is due to the fact that you started treatment when you are Immune tolerant.
In my opinion, you will e-seroconvert eventually and it will not be due to your taking Tenofovir.

[Jatashankar]

Instead changing try combo of tenofovir and entecavir

[Jatashankar]

Instead changing try combo of tenofovir and entecavir

[Jatashankar]

Yeah by this much treatment u must have been hbeag neg. ur hbsag is too high 30000!! This is not a good sign. U should change ur med and see decline in hbsag. Try vit d3 like Steff says.