Liver Transplant Expert Forum
follow up question to Dr Schiano
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follow up question to Dr Schiano

Thank you doctor for your insights.. Actually, till 2 years ago, my viral load had been 1.74 X 1000 or 1740 and my doctor said I didnt need treatment.  Sept 2009, I had a viral load of 7.84 X1000, still the doctor said I did not need treatment Then viral load went over 10,000 in Dec 2010 she said I can start treatment , however in March 2011, my viral load went down below 10,000 again.

I had been hesitant to start because of the side effects of the viral medications. Although the medications address the suppression of viral replication, they give other problems like, it can affect kidneys, or one can become resistant to it.

Youi mentioned that although my liver functions are normal, it is possible to have decompensated liver or scarring of the liver. Is it safe to start viral treatment with decompensated liver and scarring of the liver? How will you know if one has decompensated liver? Will liver functions become bad if you start treatment with a  decompensated liver. I have read warnings like before starting viral treatment, check if you have a liver disease. Isnt this conflicting? I thought you start treamnet because you could have a liver disease.

You also mentioned being tested for genotypes. Is it necessary to have this test before start of treatment?

What do you think of entecavir as opposed to tenofovir. The doctor decided I should  use entecavir because I have .  osteopenea.From what I have read, entecavir has issues with resistance while tenofovir does not have that issue so far. Do these 2 medications have interactions? Do I have to stop taking milk thistle and phospatidyl choline when I start treatment?

Thank you very much doctor for your anticipated response to my questions. Once I get answers  about safety of viral treatment and other concerns given the above situations, I will be more confident to start treatment.
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entecavir frankly is just as good as tenofovir although there is no resistance associated with the latter.  the bone disease is not that much of an issue so far. The oral HBv medications are really well tolerated without side effects. the genotype will make sure that there is no resistance already to entecavir--its is not a prerequisite before starting treatment. i doubt very much you have a lot of liver damage although it is possible although unlikely. i think you should start treatment--it will not make the liver worse.
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