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Transitioning from Viread (Tenofovir) to Baraclude (Entecavir)
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Transitioning from Viread (Tenofovir) to Baraclude (Entecavir)

My aunt is now switching from Viread (300mg) to Baraclude (0.5mg).  She had been on Viread for about 2 years but her kidney functions have worsened.  Our hepatologist and nephrologist think this is happening because of the nephrotoxicity of Viread, which affects some patients.  

In switching to Baraclude 0.5mg, she is supposed to take Baraclude every other day while still taking Viread everyday for 3 weeks.  After that, she'll switch completely to Baraclude.  No more Viread.  Is this transitioning from Viread to Baraclude typical?  On alternate days, she'll be taking full doses of both Viread and Baraclude.  Is this not toixc?  I understand that some people do combination therapy with the two drugs at full doses simultaneously.  But it does surprise me that this is the way to do it.
22 Comments Post a Comment
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Avatar_m_tn
baraclude has been found even heavier on kidneys than viread, in any case fibroguard and baking soda is what can help to preserve kidneys function and even optimum values of vit d3

since there is no cure once kidneys are damaged i do suggest to use these supplments and recheck creatinine clearance by 24hrs urine collection
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Avatar_m_tn
Have they tried to use a lower dose half a pill or every other day? I don't know it switching to ETV will do anything. TDF is more potent.

Baraclude is also carcinogenic. May be it is just better to stop the therapy for a breather a month or two.. and follow up with interferon.

As for combination therapy it is better to do antiviral + immunomodulator like interferon or zadaxin. Taking two antivirals I think should be left for people with drug resistant HBV, or very severe disease.

Keep in mind there is no gold standard on how to treat CHB. Finding a more creative doctors that is aware of latests treatment is the key, if your country laws allow they to try stuff that works.

So if your aunt is fully suppressed and was for six month or over a year, it wont hurt to stop the therapy. And let the body recover and go on ETV.. she may even maintain undetectable levels of HBV DNA off drugs. Happens very rarely but does.

They are doing about the transition based on HIV guide line I think. Worrying about possible resistance or huge HBV dna flare of drugs.. but HBV does not mutate at the rate of HIV. And not all people will experience severe hepatitis dna jump when they come off meds. TDF is a very strong drug. And as many people say it is best to stay on it, just lowering the does. Some people take TDF every other day, and they are fine.

Just talk with your doctor about options. And talk about interferon if your ant is healthy enough for it.
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Avatar_m_tn
Thanks Stef2011 and VeteranB, thanks for your comments.  Yes, she started taking 1/2 teaspoon of baking soda every night.  I'm thinking about increasing that to 1 teaspoon or more.  Her Vit D-3 is around 40 from supplementing, but I want to increase that to about 80.

I'll look into Fibroguard, but she's on hypertension medication, Amlodipine Besylate -- I'm not sure if that'll protect her kidneys from antiviral therapy but her blood pressues seems to be normal with that medication.

The larger question is, our hepa said nephrotoxicity has been shown with Viread, not Baraclude.  I believe the doc was referring specifically to the Fanconi syndrome, which affects renal tubules: my aunt regularly shows high Chloride, low Carbon Dioxide, low Potassium, and low Phosphorus.  And she's leaking protein, glucose and WBC esterase in her urine.

How about reducing Baraclude to 0.5mg every other day, since she only weighs 85 lbs. (39kg)?  I know that some people take 1.0mg everyday.  But her highest HB Q PCR DNA was 17,800 iu/ml (104,000 copies/ml), and that was an outlier; normally she's undectable at <20 iu/ml (116< copies/ml).  Her liver biopsy early this year seemed to show that her high liver enzymes (50-60) may be due to fatty liver, rather than chronic HBV.  

At 72, I don't think she's strong enough for Interferon therapy.  And her HBV really doesn't seem to be serious enough that we let her kidneys continue to deteriorate.  Sadly, her nephro is not very proactive and has not been giving us very good advice.  We're trying to go see another nephro, since now her kidneys seem to be more in danger than her liver.  Our GP seems to agree with us that we need to focus on her kidneys more than her liver.  What do you think?
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Avatar_m_tn
Oh yeah if she is 72 then baraclude is all she needed. 0.5mg is very tolerable in fact at times you hardly feel it..

On the other hand 1mg of baraclude made me really nerves when I took it. Nucs have that hyper affect but maybe not in old people.
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Avatar_m_tn
Really with tenofovir people should take half a dose for hbv. 300 mg is  an HIV dose. But they just never bother to test these drugs and just give them to us. But better  saver drugs like zadaxin  and alinia that can work for older patients with etv are not being looked at.

With tenofovir kidney damage seems to be the main issue.  Everything that was reported by patients on hiv forums about nucs we start to see here. High blood pressure; kidney damage; people reporting muscle loss. All this happens seems like after 1.5 and greater years of treatment.
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Avatar_m_tn
Hi, thanks much for your answer.  My aunt is 72 and weighs only 85 lbs.  Do you think 0.5mg Baraclude every other day would be ok?  In fact, that's what Bristol Myers recommends if your GFR is under 50.  

Either 0.5mg every 48 hours or 0.25 mg once daily, using Baraclude Oral Solution in patients with renal impairment:

http://packageinserts.bms.com/pi/pi_baraclude.pdf

I haven't mentioned this to our hepatologist yet but we're thinking about going ahead with this, since her kidneys are really the problem, not her liver anymore.
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Avatar_m_tn
Dear I think baraclude is safe option for kidney problem patients, and Entcavir dont have any complications to kidney patients but since ur aunty already developed she has to do dose adjustment based on her creatinine clearance, Baraclude Solution (0.5mg/10mL) is also available  for better dose adjustment comes in 210 mL bottle. And baraclude dont have carcinogenic effect and definitely Interferon can be only below 40yrs of age. Go for Baraclude Solution ask ur receptive dr for the same.
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Avatar_m_tn

order fibroguard from hepatitistechnologies.com as soon as possible and try for 1-2months, i had to use it while on entecavir monotherapy because it made my creatinine out of normal and fibroguard got it less than my baseline values, now 0.8 which is in the lower range of normal

now i am on entecavir plus tenofovir because entecavir was not able to suppress hbvdna totally, fibroguard also prevents fibrosis, i used the whole heptech protocol to reverse cirrhosis and as you can see from posts it did work increadibly fast together with the antivirals.i dont suggest the whole pack for you because very expensive but fibrogurad is perfect for kidneys, this allowed me to take the combo with tenofovir with no issues

as regards vit d remember to check calcium monthly too and as regards baking soda to buy the papers at pharmacy to check urine ph, with baking soda you should keep it at around 6.5-7
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Avatar_m_tn

as regards vit d it is best to keep it around 50-60ng/ml, not the higher end of normal
i also saw some early research about gcmaf and kidneys failure/or low function but i never checked that deeply, try to google it or have info on this conference:

http://gcmafconference.org/

kidneys disease
http://www.gcmaf.eu/info/index.php?option=com_content&view=article&id=156&Itemid=91

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Avatar_m_tn
How do you use baking soda? That's related to Alkaline diet right? Can you share the procedure of baking soda?
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Avatar_m_tn
just check urine ph and according to it take half a spoon of it dissolved in a glass of water
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Avatar_m_tn
Is it teaspoon or tablespoon? Sorry if it sounds stupid, I'm a direct person. Also can I substitute baking soda with lemon? It is also alkalizing right...
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Avatar_m_tn
teaspoon, you can vary amount according to urine ph, the paper to check urine ph are available at pharmacy

tot amount per day you have to check i dont remember but i think 1-2 teaspoon

making ph to 7.5-8 is in use to prevent cancer, during cancer chemio, to prevent flu, to lessen kidneys work or to boost sport performance both professionals or not...i know porfessionals use a lot of this to boost results on muscles strenght and so on
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Avatar_m_tn
best ph is around 7-8, for cancer therapy they increase it to more than 8 but this must be controlled because ph higher than 8 can be dangerous for acidic alkaline balance

dont know about lemon potency but it is not as potent as baking soda
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Avatar_m_tn
Just read your comments again about reducing TNF dose to 150mg (Cutting tablet in half) or switching completely to baraclude. I just saw my blood work results today and beginning to see increases in Uric acid and pottasium. i am considering cutting each viread tablet in half and taking each day as against taking the full dose to reduce the toxicity i am beginning to experience which is quite scary. I am also beginning to experience high blood pressure values. Been on TNF for 2 years now. Before starting TNF was HBDNA was naturally undetectable, however HBSAg 14000 iu/ml. Hbeag Negative.  Pls your advise needed
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Avatar_m_tn

do not take tenofovir 150mg without adding other antiviral in combo, the lower tenofovir dose can develop resistance

you need the correct kidneys tests first to see if kidneys damage is really the cause of increase potassium and then choose among a combo or switch.what did the doctor say about the potassium level?

it is best to see your creatinine clearance before making choices, you should also see phosphorus and calcium out of range (much before potassium), did you check them too?

italian researchers monitor me this way (since i am on tdf+etv):
creatinine clearance every 12 months (directly urine in 24hrs, not croft formulas)
monthly creatinine, phosphorus, calcium the first year and every 3-4months the following years
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Avatar_m_tn
Many thanks Stef.  he just said it was something that happens as we get older. but he didnt take it very seriously, before carrying on to feed me with other results which came back normal. Other tests that were done were:
Calcium: 2.26 Normal;
Sodium: 135
Chloride: 100,
Uric acidL 0.46,
Alk Phosphate: 81

But he did mentioned to me that all other kidney tests came back normal, with pottasium being the only test that was raised.  Since my blood pressure is raised: would taking baking soda be a good idea for me?  Is Baraclude safer than TNF? Thanks Stef
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Avatar_m_tn
would taking baking soda be a good idea for me?

can t say, you can try and see what happens to blood pressure and of course reduce sault, glucose, fructose in all diet

you may try lipo vit c as well and see what effect it has on blood pressure in 4-5weeks

Is Baraclude safer than TNF?
in general terms yes but if doctor was not concerned you may just check the tests i suggested so you ll know for sure how kidneys are and if it was kidneys
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Avatar_m_tn
taking Viread for about 2 years. ALT/AST are normal and virius load undetectible. However, got protein and glucose on urine. it was Fanconi Sydrome caused by Viread. Now I was told to switch to Entecavir.  Any advice?  Don't want to get additinal side effect.
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Avatar_m_tn
best way to protect kidneys is to add telbivudine to tenofovir or as proposed switch to entecavir

did you check creatinine before and after taking viread?did you test creatinine clearance by 24hrs urine collection.this just to be sure about kidneys function

you can help your kidneys by baking soda, 1 tea spoon per day to keep urine ph around 7, this will lessen kidneys work on keeping ph balance and maybe recover some functionality.
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Avatar_m_tn
yes. checked creatinine clearance by 24hrs urine collection every 12 month. That was how we found out protein in the urine. Kidney function is fine but got protein and glucose on urine because of the Fanconi syndrome which caused the kidney tubes releases protein, glucose and other minerals to urine instead of returning to the body.
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Avatar_m_tn
i dont have enough data to suggest switch to entecavir or add on telbivudine on fanconi syndrome

telbivudine should be able to improve kidney function but i dont know if this is also for  fanconi syndrome.if you are naive to tdf and nver used lam also entecavir is a good option
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