Viral breakthrough or resistance

[chanthou]

My son (26 years old) has taken Entecavir for 2 years.  He became undetectable for one year (less than 6UI--last year).  His test this month showed that viral load increases to 36 UI.  Liver functions normal. Is  this viral breakthrough or he is resistant to Entecavir? Or it is normal fluctuation.

[Ithnin]

Can baraclude entecavir be taken after year expire ?

[stef2011]

i've just read the studies presented at boston and entecavir failure is considered if hbvdna>35iu/ml or 38iu/ml at 96 weeks so i'd combo with tenofovir anyway resistance or not, if there are sides i'd stop combo after 5-6months and keep tenofovir only

there should be also updates about simvastatin combo with entecavir and tenofovir, etv+sim was the most potent combo, but i didn t find them

yesterday i started vit d low dose again since we are getting to the flu season and i don t want to risk flu

[chanthou]

Hi Stefano,

What do you think about my son VL?  Any sing of resistance yet? It fluctuated along the way, though.

[stef2011]

it can help as general health and help with immune modulators as shown by trials vit D+peginterferon but i think it has no help with entecavir or tenofovir

i have tried vit d+entecavir combo but it is very difficult to say if it helped or not for hbv since i am using nitazoxanide too.
i stopped it early september because of changes in creatinine within the normal range and i ahd these changes but again this is not proof it is just me:
hbvdna from und to 21iu/ml, alt from 31 to 45
bone pains and colds back again, i was free from these problems from january when i started

maybe i will restart it especially for back pains

as to your situation do monitor closely hbvdna or choose to add tenofovir

[chanthou]

Before treatment (May 2008): viral load >100 million copies
Treatment started in July 2008
3 months after treatment (October 2008): VL = 498,668 copies
6 months after treatment (January 2009): VL = 7,700 copies


9 months after (April 2009): VL = 123,500 copies
12 months after (July 2009): VL = 231,750 copies
13 months after (August 2009) VL = 838 copies


15 months after (November 2009): VL <6 UI/ml UNDETECTABLE (Cobas Taqman)
21 months after (May 2010): VL <6 UI/ml UNDETECTABLE

26 months after (October 2010) VL = 36 UI

Another question: What Vitamin D can help HBers?
Thanks.

[stef2011]

i'd monitor closely but if still 36 or higher better start tenofovir combo even before making a resistance test because he had very high viral load and it stayed high first year and also took more than a year to get it und.
the guidelines are combo if hbvdna is not und or lower than 50iu/ml by one year therapy (therapy failure), usually resistance test is made when hbvdna gets 1 log higher that's to say 300copies/ml about 50iu/ml.In case of resistance the best is early add-on (the earlier the better), not switch

as steven said small flactuations are normal below 50iu/ml and safe when a load viral load is reached by 6 motnhs therapy but in this case the viral load was high even after 6 months, can you post viral load between the 6th month and 12 month of treatment?

[chanthou]

In 2008, his blood test showed 2 upper normal ALT and HBV DNA >500 millions copies.  Doctor recommended treatment with Entecavir.  During the first year his viral load at one time was up from 200,000 copies to 500,000 copies and then down to 2,000. November last year (2009) he became undetectable.  6 months (May 2010) later also undetectable (<6 UI/ml). But, last week, it shot up to 36 UI.

[stevenNYer]

What was the reason why your son was started on meds?

Remember UND doesn't mean zero.  I don't think this fluctuation means much.  Monitor his lab trends.

[cajim]

Is  this viral breakthrough or he is resistant to Entecavir? Or it is normal fluctuation.

--I think the latter.