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Viread
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Viread

Should I start to take Viread for the following viral counts? Thank you.

HEPATITIS B VIRAL DNA, QUANT PCR            15000 copies/mL

HEP B VIRAL DNA QT                                      2480 IU/mL
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23 Comments Post a Comment
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Avatar_m_tn
Other test results?  ALT, AST, HBeAg etc.?
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Avatar_n_tn
ALT and AST are normal. HBeAg is positive.
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Avatar_m_tn

if there is no liver damage or f1-f2 i wouldn't start viread but try interferon or monitor, once you start viread you cannot stop it

interferon has the highest hbe seroconversion rates, check your hbsag quantity if lower then 1500iu/ml you have also chances of hbsag seroconversion.therapy is for 6months/1 year only
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Avatar_n_tn
Actually HbeAg is non-reactive and HBe Antibody is reactive. But the viral load went up from a couple thousands to 15,000. Should I consider any treatment?
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Avatar_m_tn

in this case i'd try nitazoxanide right away, hbvdna gets und in a cople of weeks and then see if hbsag lowers until negative by 1-2 years

if you don't feel safe with off label nitazoxanide you might wait for our results in 6months/1year and just monitor your hbvdna and hbsag quantity, if they get higher than 3 logs i d consider treatment

other choice check for hbv e-minus mutations and monitor liver damage and alt/ast and when one of these abnormal start interferon.
i'd leave viread as the last choice because it doesn't eradicate the virus but only stop liver damage and virus replication
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Avatar_m_tn

first thing you have to consider all drugs at the moment, except nitazoxanide, do not change hbsag.
they can only stop liver damage not the virus, and you have probably no liver damage if alt/ast lower than 30 or so, so approved therapies are not very usefull in your case, again i think you might try off label nitazoxanide

ask your doc why he wants to start viread since normal alt and low hbvdna and very little benefit from viread
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Avatar_m_tn
I'm a new member, also found out hbv+ from birth last year oct-2011. Dr. did blood test I start takeing viread june-19-2012 due to my blood work and biopsy.

hbeAg+
hbaAb reactive
hbvdna 528267
hbsAg reactive
AST 47
ALT 57

MICROSCOPIC DESCRIPTION: BIOPSY

The liver tissue parenchyma preservation of the lobular architecture. In the Masson trichrome-stained section, there is no increase in intrahepatic fibrous tissue.  Most portal tracts are small and free of inflammation, alothough one portal tract contains a heavy infiltrate of lymphocytes. There is no interface hepatitis.Interlobular bile ducts are unremakable. The hepatocytes are free of streatosis, ballooning, or ground glass change.  No iron pigment accumulation is noted with the Prussian blue stain.

what all this mean? please help
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Avatar_m_tn

that you have no damage from hbv

biopsy is not good for monitoring, follow up with fibroscan every 6 months
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Avatar_m_tn
I'm started viread already, is this the right treatment to do, since no damage to my liver.

Thank you, for you help
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Avatar_m_tn

since you have no liver damage i dont see any reason to use viread, are you at hcc risk?geno C, precore bcp?
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Avatar_m_tn
Stef, you are probably the one to ask...have you read any literature on whether taking Viread every other day, or taking half dose (150mg) per day is as effective as taking the entire dose every day?  This may reduce the toxic effects and risk for kidney damage.
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Avatar_m_tn
The 150mg dose will work well in most patients. But if partial resistance mutations are present like in LAM res patients, the full dosage is well advised. A paper by a Spanish group has published 100mg tenofovir with  excellent reductions in viral load. But Dr. van Boemmel, the German doctor who originally pursued Viread for HBV - against the resistance of Gilead, shamely- warned in an editorial against this dose reduction, with the argument that the excellent resistance profile of tenofovir might be compromised by this practice.

It can be speculated that once UND is achieved and resistance forming power is consequently reduced, the half dose might well be sufficient to hold this status with reduced toxicity as a benefit. But which doctor will risk to recommend this to you, since it is a deviation from the common practice and violates the FDA approved dosage?
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Avatar_m_tn
I don't know if I a high risk (hcc risk?geno C, precore bcp?). I'm going back to a Dr. in Sep-10-2012, have alots of question to ask him about viread trentemt since my liver have no damge. Beside in US viread cost about $25 per pill, if I taking this for life that alot of money I don't have. I have more blood work data for you to look at. see what you think and thank you againg for you help.

HEPATITIS BE AG              Positive                5/14/2012
HEPATITIS D   AB              Negative    
HEPATITIS BE AB              Negative    
HEPATITIS A   AB              Reactive    

FERRITIN  546                22 - 322 ng/mL          5/14/2012

HEPATITIS B DNA ULTRAQUANT   528267     12/7/2011

AST                          35                                 11/22/2011
ALT                           43      
HEPATITIS C RNA PCR, QUAL    Not Detected  

HEPATITIS B SURFACE AG       Reactive         10/21/2011
HEPATITIS B CORE IGM         Non-Reactive    
HEPATITIS C AB INDEX LT      0.02         0.0 - 0.79  
HEPATITIS C AB INTERP        Non-Reactive    
AST                          47      
ALT                          57      

AST                          46                                   10/14/2011
ALT                          52
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Avatar_m_tn

looks like you are hbeag pos, it may be good to try viread+peginterferon, even more expensive but you may clear hbv or stop drugs without problems

i d try this combo with hbsag quantity monitoring then if it doesnt lower hbsag in 24 weeks i d stop viread and keep intf 48 weeks and then stop all therapies
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Avatar_m_tn
how it can be possible 44 yo and still eag+???

I see you're eag+ and eab+... right?
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Avatar_m_tn

do you have upates on hbsag and hbeag quant?are your alt still elevated?
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Avatar_m_tn
I just got back from camping trip with my kids. My next Dr. appointment is on sept-10-2012. I will update all my blood work than.

Thank You
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Avatar_f_tn
Hi-
I need your advice please! I am a member for few days now, recently visited doctor and my test came back with these result:
AST: 54, ALT: 66
Viral HEP B DNA QT:  67700 20IU/mL   and 394000 116 copies/mL
HEP B Antigen: Non-Reactive
HEP B Antibody: Reactive
HEP B Surface Ag: Reactive
HEP B Surface Antibody QUAL: Non-Reactive    
my ultrasound is normal, does that mean my liver is not damaged? how do I find out? my doctor told me to start Viread and this is my 3rd day on this pill, but I am still wondering if I need to take it? Should I ask doctor for othe tests? and should I stop the pill?
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Avatar_m_tn
You should continue on the pill because you are over the recommended guideline for HBeAg - patients.  The current guideline is HBV DNA over 2,000 IU and elevated ALT/AST (2x).  You are over the minimum for DNA, and you're ALT/AST is slightly elevated.
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Avatar_f_tn
I've read about combo peg-interferon+tenofovir, when am I supposed to use both of this combination? or Viread would just do it for now? do you know where can I go for a fibro scan in US? how about fibromax testing? is it effective? Also, should I ask doctor to test for GENOTYPE? what does it mean?
Thanks,
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Avatar_m_tn
Fibroscan is not done in the US.  Fibromax is just taking a blood sample and then putting the lab numbers (like ALT and Triglycerides) into a formula to predict estimated fibrosis.  It is not the real thing.  

Genotype really only helps with determining course of tx.  If you are Asian and got it through vertical transmission you are probably Geno C or D.  

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Avatar_m_tn

you should know yoour liver damage by fibroscan, viread itself is useless on a healthy liver with no HCC increased risk by c genotype or precore/bcp

the only thing that makes sense is using viread to add on intf after 3 years or more and clear hbv definitively, not taking viread pills for life.these antvirals damage mitocondria over many years so the plan must be clear hbv sooner or later
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Avatar_n_tn
I have always been taught to keep the viral load undectable, to remove or lesson/Lower the chance of Liver cancer.

Also could you please confirm where in the US I could have a quantitative HBV SurfaceAntigen test conducted.

Please advise,
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