"Undetected" is a moving target, not very long ago 57 iu/ml would have been regarded as undetected. So I don't see why you should be concerned. Also it is not 100% of patients can achieve undetectable within several years of treatment with Viread.
What am concerned about is that in 7 months the virus just dropped from 74 to 57 IU/ml, and the Alt became higher. Do you think the virus will make any resistance in my situation?. Also, I'm HBeAG negative.
There has not been any report of Viread resistance and they have been monitoring it for over 5 years. ALT can change, for example, after heavy drinking. With ALT and viral load, one should not be too concerned with small variations, but watch out for the trend or persistence. Also you must take your medication faithfully as it is a frequent reason to reported flare in viral load. As for ALT, persistent elevation can be caused also by fatty liver (most unlikely in your case unless you are over weight).
hbvdna around 50iu/ml is not big concern but the usual strategy is add-on of another antivirals if no response by 12 months (no response is hbvdna detactable)
the usual choices to viread are tenofovir+ftc or tenofovir+lamivudine, i d go for the second if resistance tests show no resistance mutants for lamivudine since it is very cheap, generic and very very light sides compared to all others nucs
another good choice can be intf add on to tenofovir, follow hbsag quantity and hbvdna quntity for 24 weeks and if it doesn t work you can go for tdf+ftc or tdf+lam
as to resistance tdf has shown no resistance even if hbvdna is detactable but i dont know how long they kept ptients with detactable hbvdna, my guess is they kept them on tdf for 12 months and then added another nuc after this period
Thank you very much both Stephen and Stef for your advices. I scheduled an appointment with my doctor after a month and I hope the virus will be undetectable by then. If it is not I will tell my doctor to add another antiviral as you told me Stef.
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