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Hepatitis B Community
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Avatar universal

A Fellow Patient's Treatment History

1975 born in August;
1991 HBsAg+, HBeAg+ found;
2003 liver pain, liver function normal, DNA 8th power, tried Chinese herbal medicine for one year, ineffective;
2004 liver pain, liver function normal, DNA 8th power, started Lamivudine;
2005 Lamivudine, liver function normal, DNA is only down to 4th power, decreased liver pain;
2006 Lamivudine, ALT slightly abnormal, liver function slightly abnormal, DNA up to 6th power, YMDD mutation detected;
2006 Lamivudine plus Adefovir, liver function normal, DNA down to 4th power;
2006 Lamivudine plus a different branch of Adefovir, liver function normal, DNA-;
2007 Adefovir alone, unable to control the virus, DNA up to 6th power, added Lamivudine, DNA became negative again;
2008 mutation despite combined Lamivudine and Adefovir, changed to Adefovir plus Entecavir;
2009 Adefovir plus Entecavir, liver function normal, DNA negative;
2009 Adefovir plus Entecavir till now (October 2009), liver function slightly abnormal, DNA increased to 7th power, virus detection showed mutation.
18 Responses
1192491 tn?1265035429
In layman's terms, what does this mean?  I think it means you still have active virus in your blood??  
I don't have all the stats on my blood tests over the years but I know my blood test still comes back positve for Hep. B and adnormal liver function does show up from time to time...something about protiens...any idea what this means without the stats? encome
Avatar universal
This case shows the pain and difficulty at dealing with HBV once it gets smart and learns to deal with the drugs.  So, be very cautious with starting antiviral treatments.
1192491 tn?1265035429
Sorry to ask you so many questions but you seem to have alot of  knowlege regarding HBV.  Can you give me an example of antiviral treatments?  Would that inclde the seasonal flu shot?  Would you be referring to interferon?  I understand some people undergo interferon treatments for HepB.  This is news to me bc I thought interferon wad used for HepC only. Is there a high risk of liver cancer from HepB also?
Avatar universal
antiviral treatments = all the oral treatments, e.g. Lamivudine, Adefovir, Entecavir, excluding interferon.
Avatar universal
Female, age 59, with HBV, HBeAg+, mother and brother died of HCC.

March to June, 2005, repeatedly abnormal liver function, max ALT 348, AST 230, globulin 38.5, normal when taking Tiopronin, high again when not on Tiopronin,  HBVDNA-.

July 2005, DNA-, globulin 38.4, albumin 33.3, others normal, AFP 219.5, as the AFP value is too high, did enhanced CT, CT results normal, the doctor suggested taking Lamivudine.

January 2008, DNA is 7 * 10 x 6th power, liver function normal, mutation, YMDD detection: YVDD+, started Lamivudine + Adefovir.

June 2008, taking Lamivudine + Adefovir for six months, DNA at 10 x 6th power. Lamivudine + a different brand of Adefovir for six months, HBVDNA low to 10 x 4th power, and later rose to 10 x 6th power, liver function normal.

January 2009, YMDD mutation detection: YVDD+, changed to Adefovir + Baraclude.

January to August 2009, used Adefovir + Baraclude, DNA sometimes 10 x 3rd power, sometimes 10 x 3rd power, normal liver function, B-US: 1, liver parenchyma damage, cirrhosis; 2, multiple small liver nodules, nodular sclerosis.

Mutation test:
Adefovir (181) Wild
Adefovir (236) Wild
Entecavir (184) Wild
Entecavir (202) Wild
Entecavir (250) Wild
YMDD mutation detection:  M-, v+, i-.

January 2010, DNA at 10 to 3rd power or 4th power, liver function normal.
Avatar universal
Hi
Just one question .. does the LIVER ever pain ... I had some pain in my rib case right side and when I asekd the doc he said the liver NEVER pains ...
Avatar universal
you have been very very unlucky to have met the wrong doctors, it was well known to researchers and advanced doctors about lam and adefovir worsening illness and not curing, now entecavir and tenofovir are another story but you have to be naive,i have been very lucky that the team of researchers in my city knew this and i also knew this reading trials

in your condition i would start alinia even if off label, it is active against all resistant strains hbv and change immediately adefovir with tenofovir (adefovir is very very weak and toxic) + entecavir and eventually Emtricitabine, unfortunately after all these mutations combo entecavir+adefovir is very weak and wil lead to another mutation

i also hope you are not under the same doctor who lead you to all these mutations because he is absolutely not a good doctor

you have to keep the virus und otherwise there is not a lot of meaning in treating with antivirals because they immediately lead to resistance, you have to get und for a couple of years and then when replicor drug will be available you will be free from resistance and hbv
Avatar universal
Of course, doctors may cause mutations if they prescribe antivirals at the wrong time or in the wrong combination.

How about patients themselves?  How many of us don't feel we are being treated unless we get a bottle of drugs from our doctors?
181575 tn?1250202386
That August 1975 born chronic HepB patient is a classic example of poor treatment.

It's not the antivirals, it's poor management of using them.  

I would question why LAM for over 1 year, then why go mono Adefovir?, then why is Entecavir resistance NOT expected since there is already resistance to LAM.  And would it surprise anyone if even combo Entecavir and Tenofovir fail at this point?
Avatar universal
Male, born 11/03.
09/03, diagnosed  with HBeAg-, HBeAB, normal liver function.
06/06, ALT 210, AST 120, took herbs, 1 week to ALT 970, AST 360, liver biopsy G2, hospitalized, used some Chinese medicines, 1 week later ALT 220, AST 120, started LAM
LAM for 1 year, liver function normal, HBVDNA-, 2 more years of LAM.
08/09, stopped LAM, 3 months later ALT 740, AST 340, HBVDNA 2.96 x 10 to 7th power.
10/09, ALT 365, AST 110, TBA 24.9, CBE 400, GGT 511, tried some other western drugs, ALT 430, AST 200, tried herbs again, 1 week later, ALT 740, AST 374.
12/09, ALT 1800, AST 800, HBVDNA 5.1 x 10 to 7th power, tried western medicines again, 1 month later ALT 555, AST 330, HBVDNA 5.1 x 10 to 7th power.

To respond to Steven's comment above:  Yes, with hindsight we can say it is "poor management of using" what were available then.  But what I fear is: 10 years from now, how do we know combo Entecavir and Tenofovir is not the same as LAM?
Avatar universal
Yes, a pain in the lower right ribcage is due to a swollen liver.  Hepatitis is a word meaning inflammation of the liver.  The pain is due to the swelling.
181575 tn?1250202386
cajim: To respond to Steven's comment above:  Yes, with hindsight we can say it is "poor management of using" what were available then.  But what I fear is: 10 years from now, how do we know combo Entecavir and Tenofovir is not the same as LAM?


You're right, no one has a crystal ball but we go by what we know now.  There are no guarantees in life.  But what we know now is alot more than before.  Remeber we don't say everyone should treat, we say in certain cases because the alternative in these cases is active hepatitis.  Also, alot of the treatment for HepB is acutally from the HIV model.  HIV combination treatment is the norm for the same reason, to prevent resistance.  And it has been successful for many many years.  For HIV, the alternative is a rather quick death.


jhakas:  "liver pain" is commonly reported for those sith chronic HepB.  The liver itself feels no pain, but inflammation could pressure surrounding organs, tissues, veins, etc, so the pain is from that.
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