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Avatar universal

Baraclude vs. Viread

Hi All,

I am an male in my mid-20's of southeast Asian decent, and I'm quite torn about how to proceed. I acquired HBV through vertical transmission and am currently in the immune clearance phase.

My ALT levels are 5-6 times normal.
I am e-antigen positive, e-antibody negative.
My viral load was 30 million in Oct 2008. Since then, I've been taking a cocktail of herbs intended to treat hepatitis (including milk thistle) and in Jan 2009, it is now 13 million.

I am torn because my family would like me to stay with herbal cocktail, but several doctors want me to begin treatment. The doctors say the fluctuation in viral load is natural and not necessarily tied to my use of herbs.

Firstly, has anyone had success with the herbal remedies?

Secondly, if I begin treatment, the goal would be sero-conversion (i.e. e-antigen negative, e-antibody positive). Would that essentially mean I'm cured and won't need to worry about HBV anymore?

Thirdly, my doctor says it's pretty much a flip of the coin to decide whether to go with Baraclude(entecavir) or Viread(tenofovir). There seems to be very little data about the success rate of either. Can anyone please help me to decide which route to take? For example, comparison of side-effects, success rate(i guess that means sero-conversion) in asians, etc.

And finally, how much of a difference would it make if I start treatment now or in, say, 6 months?

Being 25, I will potentially be taking this pill for many many years, so I'd like to make the right choice.

I'm new to this forum and would very much appreciate your time.
219 Responses
Avatar universal
Hang on.  I want stevenNYer to see this.  He'll pop in soon with some advice for you.
Avatar universal
If antiviral is the route you choose, then your ALT and VL reading match the 2007 guideline recommendation for treatment.  Both Baraclude(entecavir) or Viread(tenofovir) are effective in this line of treatment.  When you choose the latter, you need to keep an eye on your creatine level (kidney damage indicator).
Avatar universal
"Firstly, has anyone had success with the herbal remedies?"

I am trying a non antiviral remedy but it will take 2 years to see the result.
Avatar universal
Thanks for the response. Then why would I choose Viread at all? Why not just go with Baraclude? Is Baraclude supposed to be safer?
Avatar universal
Because Baraclude has its own headaches, e.g. the Chinese HBV site often mentions concerns about Baraclude relating to cancer.
181575 tn?1250202386
Welcome to our forum.  It's nice to see a first time poster having done some research and learning for himself before asking questions.  It just makes it easier and more meaningful when we don't have to explain the basics.

Firstly, I think herbal remedies are okay to use to support liver functioning.  But don't expect it to help you "e" or "S" Seroconvert.  In terms of stats, it's not going to happen.  It also won't limit or stop viral replication.  You labs pretty much proves this point.  

Secondly, even if you successfully "e" Seroconvert in time, you still need to monitor your condition.  Disease "re-activation" is common among "inactive carriers", especially over time.

Thirdly, choosing between Tenofovir (Viread) and Entecavir (Baraclude) is like flipping a coin.  Both have good antiviral power.  Both have minimal side effect.  Both have little things to worry you a little (as pointed out by cajim's post).  Neither have research showing negative effects of long term use for HepB.  So far so good.  If you could only get your hands on one (depending on your insurance coverage and wallet size), either one is fine....But if you could afford both, do both.  Given your high viral load, do all you can to minimize risk for antiviral resistance.  Combo it to x-fold the antiviral power and down the DNA quickly so the virus loses its adaptive power (that is has in large numbers...13 million in your case).  Combo until you "e" Seroconvert or even until you reach UND DNA and go mono with either Tenofovir or Entecavir.  You will buy your med more time this way.  As you say, you may need to take this for a long time.  You need to protect you cross-protect your meds to make sure it works for a long time.

Finally, if you made a good guess by a series of labs that you are in immuno-clearance phase, treat it.  Waiting 6 months won't make much of a difference but why wait.  You ALT shows you your liver cells are taking a hurting.

And welcome to my boat...the "e" Seroconversion could take time...I know...all to well....

Good luck to you.  Stick around and let us know how you are doing.
Avatar universal
Thank you for your lengthy reply. I tried to go back and read some of your posts since it sounds like you have a good amount of experience with HBV, and I am quite impressed by the thoroughness of your posts. Your dedication to helping the community is really quite touching. How long have you been trying to seroconvert?

Viread offers a 5% chance of loss of HBsAg in 48 weeks while Baraclude offers a 5% chance in 96 weeks. Do you think it's safe to conclude that Viread has a higher chance than Baraclude of wiping out the virus?
Also, since Viread and Baraclude are both meant to lower the viral load, it seems treatment should be combined with Pegasys (which provides roughly a 10% chance of "s" antigen loss) to boost the immune system for maximum efficacy...at least that's what my common sense tells me since Pegasys is most effective when ALT levels are elevated and viral load is low. I mean, isn't that what we all ultimately want? To lose that "s" antigen? Losing the "e" antigen still means lifelong bloodtests...

I feel somewhat uncomfortable taking both Viread and Baraclude. Is there conclusive data showing the safety of taking both simultaneously? Is that what you're currently doing? If so, have you noticed any side effects with either? or both?

Also, does anyone know where the magical Indian herbal cure for hepatitis stands today?

Thanks again for your last post. It's nice to know we're not alone in this seemingly never-ending journey...
Avatar universal
For Viread:
"...by week 96 of Study 103, 6 percent of all patients continuing treatment in both groups experienced “s” antigen (HBsAg) loss, which contributes to resolution of chronic hepatitis B infection (HBsAg seroconversion rates were 4 percent among patients originally randomized to receive Viread and 5 percent for patients who rolled over from Hepsera)."

For Baraclude:
"treatment with entecavir for up to 96 weeks (n = 354) resulted in...2% for HBsAg seroconversion (5% for HBsAg loss)"


According to these studies, seroconversion of "s" antigen is more likely with viread (4%) than with Baraclude (2%). Either way, the chances are low, but I prefer 4% low to 2% low. :)

Thoughts?
Avatar universal
AM,

My own approach is to not continuously strive for the Holy Grail of an "s" seroconversion which occurs at a rate of 1% a year.  Instead, when the time comes for me to choose a treatment option I will focus on disease management with the best long term results based on currently available data.

181575 tn?1250202386
I found out that I have chronic HepB by chance in 2005 and treated and waiting to "e" Seroconvert since then.

Forget "s" Seroconversion,  1%, 5%, whatever, I don't expect it to happen.  Disease management is the way to go.

As for the "herbal cure", countries where Hep B is endemic all have magic "cures".  Bottom line is they don't work, otherwise they won't have a HepB problem.  Did this logic lose anyone?  Be warned and spend your money wisely.

It's interesting that you mentioned pegsys.  A good treatment strategy is to use use pegsys to bring down the DNA, then use mono-therapy with either Tenofovir or Entecavir to keep it UND.  This strategy is also to keep the risk of resistance down.  

I didn't consider pegsys for myself because I can't risk the side effects, since I am, as they say in the "prime of my life". Just too much things to do and if I can't do it, it puts too much pressure on my family.  For chronic carriers, the expectation for treatment should be to reach inactive carrier status or stay UND.  Interferons or antivirals?  Antivirals for me.

So listen, naturally I get 1%,  Entecavir gets 2%, Tenofovir gets 5%, since I am combo-ing with these meds, does that mean I have a whooping 8% chance to obtaining the Holy Grail?  Hahaha.  You have to be realistic and have a sense of humor in this.  And I'm fine combo-ing.  I'm still here and kicking (and avoiding those, windows, and I had sex with a pro and I worry about HepB posts).  And No sides.
Avatar universal
Hi Steven,

If I were to go ahead with the Viread/Baraclude combo therapy you suggested, is there an optimal dosing of each that you would suggest? Do the "experts" agree on how many mg of each?

Thanks!
Avatar universal
Not sure, but maybe:

Viread 300mg/daily
Baraclude 0.5mg/daily
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