Avatar universal

Can I take Tenefovir with undetectable HBV DNA baseline?

I have symptoms that tells me all is not well with my liver, even my fibroscan read 7.6kpa and Alt 68. I am 30yr old male.
Can I take Tenefovir with undetectable HBV DNA base?
8 Responses
Avatar universal
ALT and fibroscan can increase because of other health issues and life style as well, so you need to find out the cause for their increase despite your undetectable hbv dna. Probably you need to find out the quantity of your hbsag.
Hello, I am 30 years old chronic hep b for last 17 years. I am taking Reviro Tenovofir 300mg for last 1 year. Latest test results normal LFT, undetectable hbdna, hbeag -ve , HbsAg Quantitative 3790iu/ml and fibroscan stage 3. What shall I do at this stage? Plz help me.
Consult your dr you should use your medicine at least 5 year or may be lifetime as decided by your dr.your fibroscan value is little high which indicates some damage in liver which will be repair after use of your medicine.
In this case which one is effective tenovofir or entecavir?
Avatar universal
Thanks Liverpatient. Hbsag is also very high - 49,000 iu/ml
I'm a little bit puzzled by your undetectable level of hbv dna, because that is not common for chronic hbv carriers not on treatment. Make sure it is correct, and together with your liver specialist you've to decide whether to start treatment or not. Good luck
Avatar universal
Well, it is detected but less than 20 iu/ml. I meant to infer it is very low. I feel tired but not so much that I lose it, have backaches and a couple of joint pains. No abdominal issue or pain.

I just want to be sure there's no issue using TNF on a very low viral load.
If I were in your place I would start treating with antivirals, but the decision to treat has to be done by liver specialists. I don't think there is any issue about using tnf or other aniviral no matter the level of hbv dna. Those with kidney problems should better avoid tnf and rather use its equivalent taf or entecavir. I'm currently using entecavir because I've chronic kidney disease as well.
I just found out that there’s a new drug from Gilead that is a 2.0 version of tenofovir.  It has no impact on kidneys and bone density.  Here’s the link https://www.hepmag.com/article/gileads-hepatitis-b-treatment-vemlidy-safer-bones-kidneys-viread
Avatar universal
Thank you for your kind advice. I will surely consider it. Doc actually did place me kn antiviral saying my case is not rare and that I can stop when I go lower than 500 iu/ml which I think might be hard considering the high number. I just wanted to have more opinion as it's a lifelong decision. I am sorry to hear about the CKD. How do you feel with the entecavir? Any reduction in HBV related symptoms?
Yes, antivirals have to be taken for life in most cases, because stopping them almost always results in the rebounding of the virus. It is a bit sad, but we don't have an option right now, as the hbv drug development is taking too long time.
I've been taking entecavir for a few months now, and I don't feel any new issues form the drug, but my problems with muscle and joint aches, tiredness, etc are continuing. I am hoping for some reduction in these symptoms with time. I think the problem with this disease is that its effects goes up as we age. It is possible I contracted the disease either during birth or during early childhood, but I started to feel symptoms when I reached around 40.
I started to feel mild symptoms since 2012 when I was 25yrs. Not very serious symptoms till now.
How about checking for HepD? Is it possible to be coinfected with HepD and have a low dna reading? Just asking
Avatar universal
I don't see the point of antiviral, Tenofovir or Entecavir, when your viral load(hbvdna) is already so low, < 20 iu/ml. Antiviral is used to reduce viral load only, it does not directly affect ALT. Also your serum HbsAg is very high and seems to be incompatible with your very low viral load without any medication. What is your e-antigen status?
I believe you need to re-test your hbvdna and or serum HBsAg.
Hbeag -ve, Hbab +ve

The Hbsag quant have been that high on two different readings of 3 months apart (first 52k then 49k).

I have conducted another test for Hbsag and should have result in one week time.

HBV DNA has been less than 20iu/ml from 5 years till now since I first did the test... at two different places.

I just want to be sure I am doing the right thing and not regret knowing early without treatment.
Avatar universal
Thank you for the information. You did not indicate when your HBsAg were taken, most unlikely recently. If your viral loads have been low for 5 years, your hbsag cannot be so high. There is a slight chance because of your persistent low viral load that your elevated ALT may indicate a clearance of your hbsag. Your mild fibrosis maybe due to previous damage when you were hbsag positive, or fatty liver. Anyhow, you should definitely wait for your new test results before starting anything.
Hbsag taken on Sept and Nov 17. Alt was 80 (Oct 17) and 84 (Nov 17) now 68 two weeks ago.
Avatar universal
It is very strange that your dna is low but, one thing to concider is checking for Hep D you may well be coinfected with Hep D
I think I might have checked sometime ago. Will check again anytime soon. Thanks
Avatar universal
People, so the HBSAG Quantitative is out and it reads 42,000 iu/ml. I am so confuse.
I am certainly very confused too. Let me recap:
You are 30 years old, recent ALTs:  80 (Oct 17) , 84 (Nov 17),  68 (Mar 18).
HBeAg -ve, HBeAb +ve.
Viral loads < 20 iu/ml for last 5 years.
HBsAgs:  52K (Sept 17), 49K (Nov 17), 42K (Mar 18).
Fibroscan: 7.6 kpa.
Generally unwell, doctor recommended treatment.

Why your HBsAg is so high when you are HBeAg -ve with very low viral load is a complete mystery to me, with my limited knowledge and experience.
So, the best I can suggest is for you to see your doctor and ask him/her for an explanation. When you do have an explanation, please share with us so we can all learn from this.
All the best.
i was in similar  situation where my hbv dna was low, but detected in range of 29 iu/ml or lower, and sometime undetectable for 5+ years while i was on viread.  i was seroconverted on hbe antigen, after 5 years on viread. but due to medical induced mutation while initially being treated on lamivudine,  and my doctor was always puzzled by my high alt, which was in similar range as yours, mostly in 80s, sometime spiked to triple digits.  normal result on liver ultrasound and liver biopsy, my doctor told me i have the wild type,  but i never have fibroscan or hbsag done quantitatively
i do not know if there is any correlation between viral load and hbsag, my doctor treated me based on my high hbv dna viral load initially, and from my experience, the hbv infection varies on periodic basis.
Segemenge has never been on treatment! Viread will drive down your hbvdna, but not your hbsag. If one’s hbvdna is low without ever been on treatment, the hbsag should be low, much lower than 40k.
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