anyone experienced the liver toxic of Viread

[sirfrank]

I am a HepB carrier and monitor my virus and ALT every 6 month.
Jan 2009
virus DNA 170,000 copy/ml
ALT 35

June 2009
DNA 35,000 copy/ml
ALT40

Jan 2010
DNA 750,000 copy/ml
ALT 120

So my doctor suggested to start the anti-viral treatment this January. I decided to wait 2 more months as I would like to try with Milk Thistle with some other herb, so I was taking milk thistle last 3 months.

March 20, 2010
DNA 20,000,000 copy/ml
ALT 230
My doctor said I need start the treatment ASAP. So I started to take Viread on 3/25 (300mg per day).

I experienced nausea, vomiting, quickly getting tired after taking the Viread, so I reported the problem to my doctor. on 3/29, he asked me to go back to check liver function and he told me today that my ALT is 2100 now. He asked me to stop the Viread right away.

Any people experience the same problem with Viread treatment? If yes, how can a medicine be so toxic to liver to increase ALT 10 times within 4 days.

What should I do now? My doctor asked me to rest in the bed for one week now.

[stef2011]

they just can help to reduce oxidative stress on the liver to recover fibrosis or liver damage after virus replication is und but they make absolutely nothing to the virus especially with a viral load of 20 millions

[darkchoc]

You can consider alternative therapies. Diet can help a lot.

The following two types of diets recommend cutting out all dairy products and sugar (not to mention alcohol). They emphasis fresh vegetable juices.
The Liver Cleansing Diet
The Fit For Life Diet

Best wishes.

[stef2011]

if you don't find answer from other tests, you might also check if virus has had a precore/eminus mutation

when i was 19 i had alt at 1400 for 6 about month and changed status from inactive carrier hbe/hbeab negative to seroconversion hbeab positive inactive, at that time it was not possible to check hbv mutations at hospital but i had probably a mutation since acute hepatitis like that is not common on cronic hbv or an infection with another virus, i am checking about that now but 99% i had a precore/eminus mutation.this phase is also called immune escape but usually doesn't make acute hepatitis like yours or mine

[sirfrank]

After one week, my ALT is reduced to 1100 AST is 340 , still wait for the HBV DNA result.

Also my lipase is higher 132 (normal range 7-60). There are 3 possibilities based on doctor.

1. Medicine toxic caused by Viread. It is very rare, but it happened to me.
2. Super Infection. Suddenly my immune system started to kill the infected cells. At the same time, HBVDNA need go down. So wait for that result.
3. Problem with Gallbladder (stone there comes out, block the bile duct) which caused both liver function and pancrea function abnormal. I just did a ultra-sound to confirm this.

Hopefully the testing result of 2, 3 will shed some lights.

[stef2011]

jsut make lactic acidosis blood test or make tests to see if it was over reaction of your immune system, you cannot make guess on such an important matter

also check if hbvdna is still so high

lactic acidosis can also have no synthoms and takes months/years so i would say it was lactic acidosis until i see lactate blood test (it s italian, i don't know if it has same name in english).

[ytdthjznyj]

Exclude a superinfection?

[cajim]

If you consider IFN treatment, the following factors may add to your response rate:

1.  Caucasian
2.  Genotype A or B
3.  High ALT
4.  Low HBVDNA

High HBVDNA is not necessarily correlated to liver damage as shown by the fact that many HBeAg+ HBVers have high HBVDNA but little liver damage by liver biopsy and by the fact that some patients with decomposition, cirrhosis, and/or ascites show normal or close to normal ALT/AST, low or undetectable HBVDNA and sometimes even HBsAg-.

One view expressed in the Chinese HBV site states that IFN, herbal treatments, and Milk Thistle treatments are used, elevated ALT, AST and HBVDNA are expected much like a boy poking a bee hive: no poking, almost deserted looking hive; poking, bees everywhere.

[stef2011]

in any case the most dangerous thing is the high hbvdna you should work to lower that if it doesn't lower by immune system, if you see that you have lactic acidosis (as i know takes months to happen) you might try interferon or alinia or combo of both

check also your hbsag level so you may know if interferon might be a good choice or just a waste of time

[sirfrank]

Thank you for the comments.

My symptom is gone (vomiting, nausea, stomach pain and tiredness) after stopping the Viread last night. The doctor said it is very rare but it must be liver toxic since my symptom is gone now. Doctor asked me to check ALT again tomorrow to see if it comes down after stopping the viread.

Although ALT is high, all my other liver functions parameters are normal. I suspect the viread cause the lactic acidosis which is a big warning in the label. It is rare but happens to me.

I am hepB e antigen negative, e antibody negative, do not have cirrhosis.

[stef2011]

if they see it is drug toxicity you can try entecavir but with 20 million it might be not enough potent and resistance can be an issue if hbvdna is not und or very low by 6 months etv

there is not much difference with tdf and etv on toxicity profile for liver (exept if you have cirrhosis), etv is less toxic on kidneys that's all

[stef2011]

it is almost impossible it is viread toxicity and it is possible it is your immune system killing infected cells, that's to say it is a good sign but at the same time hbvdna pcr must get lower, if you have chances to get to a specialized lab they can check what is happening

i guess herbs have made a big big mess because having hbvdna 20 millions it means you have a lot of infected cells, i think some herb depressed immune system and virus infected a lot of cells.herbs in most cases are more dangerous than anything else on seroius illnesses
you have to worry only if hbvdna gets higher altogether with high alt, in this case viread and immune system are not working and alt is related to virus or toxicity, do not worry about alt numbers i had alt at 1400 about 6 months when i was 19yo, you  just need a very expert liver specialist and monitor liver parameters while on high alt

i suggest to wait for your immune system to find a balance between alt and hbvdna by itself (20 million vieal load is very very much, are you hbe postive or negative?) and restart therapy with viread or interferon later, viread is also the strongest antiviral at the moment

[Sharp7]

I paste from http://www.viread.com/common/Viread_FPI.pdf

The good part:
"ALT elevations generally occurred within the first 4–8 weeks of treatment and were accompanied by decreases in HBV DNA levels. No subject had evidence of decompensation. ALT flares typically resolved within 4 to 8 weeks without changes in study medication."

The not-so-good part:
"No significant change in the tolerability profile (frequency, nature, or severity of adverse
reactions) was observed in subjects continuing treatment with VIREAD for up to 96
weeks in these studies."
I believe that they do not include ALT flare as one of the adverse reactions.

Entecavir has fewer side-effects... talk to your doctor about switching to that.