A serious ETV question

[FlyingHippo]

Hey, today I asked my doctor in China for the resistance of ETV, he casually told me most of ETV resisted patient in his hospital (a very good and big hospital in China) had passed away.
Later I had a talk with a Japanese HBV doctor who is also a professor from Tokyo Medical University , mentioned ETV as well, he said there would be serious nagetive effects of ETV probably happens after 10 years ETV oral therapy, very serious (He didn't say what it exactly is).
Is TDF still able to work after a ETV resistance?
TDF is not approved yet both in China and Japan, now ETV comes to be a bit horrible, what shall I do T_T

[stef2011]

i think the doctor exaggerated but we can have this data about uncontrolled flares after resistance from china only, all other countries have tdf and will never let a patient in such a status

booklets of these drugs report possible death due to liver failure in case the drug is discontinued

[StephenCastlecrag]

They use Lam + ADF when resistance to Lam developed. I can understand people dying from cirrhosis due to uncontrolled high viral load of hbvdna due to multiple resistance. But how long has ETV been available in China and in just a few years, all these patients died and all because of ETV resistance? Incredible.

[stef2011]

etv+adv will develop resistance too once lam is used, there are a series of secondary mutations to lam that confer multi resistance

for example i have naturally q215s which allows non response and easier development of resistance to lam and adv and prepares the road even for reduced response to tdf

in a word we carry naturally mutations that can make single or multi resistance and only ultra deep sequence can tell you in advance which ones you carry, in this mess no reason to use antivirals that can make resistance and mess up everything, better go directly for tdf or etv

[FlyingHippo]

OK, understand, in a word, try best to avoid resistance.

[StephenCastlecrag]

I agree. In China, they used Lam as it is the oldest and cheapest, and we know resistance to Lam renders ETV less effective. However, they used Adefovir add on when resistance developed with Lam. So the remark that patients with ETV resistance died makes no sense to me. Something is lost in translation.

[stef2011]

etv is of course not the best choice if tdf is available

[stef2011]

this can easily happen in china if they used all previous antivirals monotherapy (i see this was used very often in china).

by these monotherepies you develop all the dangerous primary and secondary mutations that can make a dangerous flare which has no means to be controlled and liver failure may not be uncommon especially if we have damaged livers, if you add that these mutants viruses are left to replicate freely for some years

it is strange most passed away, maybe he ment many passed away

[StephenCastlecrag]

If you study all the guidelines, NICE, APASL, EASL, and AASLD, they all recommend ETV or Tenofovir as first line choice.  So I don't know where you get your impression from. BTW, only ETV, not TDF, is approved in Japan.

[FlyingHippo]

Actually I doubt a lot on these remarks. But that makes a bad mood.
But I really wanna know why in US and British there is usually just TDF but not ETV, it seems ETV is not recommended in some countries.

[StephenCastlecrag]

"most of ETV resisted patient in his hospital (a very good and big hospital in China) had passed away. " I find this throwaway remark rather disconcerting. For a patient to pass away just because the patient developed resistance to Entecavir does not make sense.
As for the Japanese doctor, I find his remark hard to take: does he have a scientific reason or just a feeling? And why 10 years? Sure as a doctor, he has a duty to warn the patients if he has any doubts about Entecavir.

[FlyingHippo]

So TDF still works even the patient already have a ETV resistance?

[stef2011]

by tdf online which is much safer than etv as regards mitocondrial toxicity on longterm use, has no resistance, most potent, cheaper and about to lose patents

buy it online, cipla is a very good brand

if china and japan dont have tdf i dont know how to explain this, it is a hiv drug too so how can it be possible not to have it?it is the only one with no resistance so it is obvious patients dye after they develop adv and etv resistance, tdf is the only one to stop hbv when it develops resistance to the other antivirals

it is increadible people is left to dye for such a stupid thing as tdf not sold in those conutry