How to know if Entecavir stopped working

[Aydin1358]

Dear all,
First I have to really thank for all of you who are giving us lots of good information.
I am 33 years old man and I think I have Hep B from birth, because of our family history.
I started taking Entecavir 2 years ago and the reason to start treatment was having 640 milion copy/ml of DNA and ALT more than normal range (almost two times of normal ). So Doctor decided to treat. Almost after a year of taking Entecavir my DNA dropped to 20 copy/ml, but still ALT more than the normal range. Then 6 months later DNA increased to 70 with abnormal ALT and  6 month after that DNA went up to 137 with ALT 70. When I started treatment my Hbeag was positive but after a year it turned to be negative and Hbab get positive.
Now I am a little worried about Entecavir suspecting that maybe virus gets resistance to it because of my DNA increase but doctor telling me that these variations in DNA are ok since it is not too much variations and the most important is that your e-antigen is negative. Yesterday I again tested for DNA test but really I am worried.
Any comments and suggestions will be much appreciated.
Aydin

[Aydin1358]

After being on ETV+TDF combo for 6 months, I discontinued ETV and went alone with TDF. Now after being 7 months on mono TDF,
Tests show that my HBV DNA is less than detectable amount of 20 iu/ml. I think TDF doing pretty good job in terms of suppressing HBV DNA.

However, my blood test still shows that my ALT is in the high normal range and fluctuating between 60 to 80. I am getting worried about this.

I have not been able to find fibroscan and will continue to find one soon. What are the possible reasons for this elevated ALT?
Does ultrasound or MRI can help me in identifying fatty liver?

I have noticed from my results an increase in ferritin levels as well. Not too much, but a bit higher than the upper normal range.

BMI=25.68.  
HDL=29.6 and LDL 106, with total Cholostrol of 168.5, if you think these data will help in identifying the reason for having higher ALT.

Thanks,

  

[newtr]

indian brand for entecavir  is entica from ranbaxy company and costs 80 indian rupee which is around one and half doller. i dont know for tenofovir but i will find out and share.

[studyforhope]

if your vl on tdf goes above 150 iu i would go back to combo and stay there.

With your hbsag of 14000, the liver is densely infected, better stay on the safe side. The fibroscan will guide you re additional efforts, like heptech or intensely healthy lifestyle measures.

[Aydin1358]

This is a very good news that staying only with TDF would not hurt and would not make things worse. I will try going off combo and see what happens. Hopefully will not need to go back to combo, but will monitor my situation closely, in case I need to go back to combo.

What will determine going back to combo? If I still detectable even very low after 6 months of combo, does it

I will also consider fibroscan soon.

Thanks a lot,

[studyforhope]

You can try tdf only without risk of loosing ground when switching back to combo in say six month after thorough testing.  
You should have a fibrioscan to determine your livers fibrosis status. Heptec holds the realistic promise of protecting the liver from fibrosis progression, but it is overpriced.

[Aydin1358]

Thanks for the information regarding Indian drug. I will try it.
So my understanding is that you suggest taking both for sure. What if I only discontinue taking ETV for 6 month starting now and see if hbvdna rises, I again back to combo. Is it possible that these mutations going to increase and make TDF not to work properly? Or TDF still will be effective with no resistance issue if I only take that?

Do you also suggest me taking Heptech products to avoid possibility of having fibrosis due to having higher ALT than normal (1.5 times than normal always)

[studyforhope]

You will likely see a small rise in hbv dna when switching to tdf only. These two antivirals have a mildly additive effect when taken together. It is possible that you have some partially adaptive mutation in your hbv genome that explains the less than perfect response. If you have to pay for tdf yourself it would be advisable to buy it from india via internet ordering, you can save more than 70%. i dont have the website handy, but you will find it if you look long enough. I think one of the indian names for tenofovir is tenvir. The indian pharmaceuticals are of the highest quality, you do not need to worry.

[Aydin1358]

Thanks Stef;

I am wondering why my hbvdna goes down so slow.
Now almost 3 years on ETV with the last 6 month of  added TDF.  
I have already taken ETV one and half more month than the date of blood test that showed 13 IU/ml.
What may possibility happen if I stop taking ETV? Can I start taking it later if I see any rise again in my hbvdna?

[stef2011]

it would be best to wait for hbvdna und, you are close to it maybe one more month

hbsag doesn t matter now

[Aydin1358]

Hi everybody:

After being on ETV+TDF combo for 2 months, my HBV DNA reduced to 30 from 70.
Now after 6 months, the number has reduced to 13 iu/ml. My ALT is also 1.5 times of the normal still.
I did Hbsag test and turned out to be 14000 IU

What do you think now. Can I stop taking Entecavir now safely and go only with TDF. I can not afford to have both at the same time.

Regards,

[Aydin1358]

Finally after lots of discussions with my doctor, he agreed to prescribe TDF. From today I am going to TDF+ETV combo. I have to pay for TDF out of my pocket which is expensive almost 610 $. But ETV is covered. Lets see how much difference this combo will make.  
I just need Hbsag measurements and need to discuss with my Dr. where we can do it in Canada. not knowing this, I will have no idea when should I start Interferon. I just hope that since my ALT was always high, my hbsag has lowered considerably. we will see.

[stef2011]

12.30 nmol/L

extremely low but convert to ng/ml which is the correct unit for vit d.for optimum health and immune system you need 60-90ng/ml (normal range 50-100ng/ml)

2000iu is nothing it wont work if vit d is low due to chronic infections, you need at least 10.000iu daily and then recheck in 4 weeks to see if it has increased or not.you need both vit25oh and calcium test to see if everything is working correctly

which form and brand of vitamin d you suggest?
only vit d3 which is the natural form, puritans is ok because they make 5000iu pills and 10.000iu pills and very cheap

[Aydin1358]

Today i got my results regarding vitamin d.
My vitamin d total is 12.30 nmol/L. seems soooo low/ is'nt it?
I was reading your previous posts regarding this, and as far as i understood, i need start taking 1000 Iu per day of vitamin d pills? Am i right? My doctor told me start with 2000 IU?
which form and brand of vitamin d you suggest?

[Aydin1358]

how long have you been on ETV? if more than a year and 1500 IU/Ml, it signals that maybe ETV not working well. In 24 weeks you should be less than 24 IU/Ml in order to say that ETV works

[DavidEurope]

So, I got the answer. He said that there is no reason to panic when the viremy is one month little higher. He said, we will see another result after this month and then we will take a decission. It is little stressing but I still trust him, so, I will see. However, he said that my temporary viremy 1500 UI/ml is very small, no reason to be scared.

[DavidEurope]

It seems I am becoming resistant for ETV too. I am still waiting the answer from my doctor after my last blood test....

[veteranB]

That is just great. Why give us antivirals in the first place to create super viruses.

[stef2011]

hbvdna und makes no difference if the hbsag has mutated to forms cytopatic, liver will be damaged anyway with hbvdna und, ast/alt normal

[veteranB]

Please explain hbvdn , never heard of it

[Aydin1358]

As far as I read answers of stef and studyforhop from other threads, in order to start Pegint you better to be undetectable for awhile, then need to also measure Hbs ag and monitor to see that decreasing. I have asked my doctor about the availability of this test in Canada and have not yet get answer from him. If not available here, Stef has already found another solution by sending it to india.
Thanks guys for your big support by helping each other.

[stef2011]

Folks over at UCLA Aids center (good doctors there btw) seem to think Truvada is the safest bet to avoid all resistance period.

truvada is just marketing for patent, tdf is the first to lose patent and truvada the last.
tenofovir has no resistance for hbv because even if there is resistance to tdf the high dose 300mg makes tdf work anyway...so etv resistance wont make any difference to response to tdf.
etv resistance is a problem because hbv can become cytopatic with some mutations, at that point having hbvdn und makes no differece to damage

[Jeff912000]

What about your HbsAG quantity.  This is so important nowadays.  NOt just DNA.  

[veteranB]

Man you sure beat me I had 500,000,000 HBV DNA boy did that made tired. I am with you there brother :( these kinda viral loads are just dangerous.

If your ALT is abnormal why won't they give you Pegasys.. Elevated ALT + viral load = immune system is fighting..

[veteranB]

You guys don't think for folks with elevated ALT it is better to start doing Pegasys?

If he developed resistance to ETV then he will for sure develop resistance to Tenofovir. They just have not being treating long enough people with HBV, All the data mostly is coming from HIV/HBV infected folks.

Folks over at UCLA Aids center (good doctors there btw) seem to think Truvada is the safest bet to avoid all resistance period.

But I think guys the answer for us is not so much just suppressing the virus but immune system recovery/stimulant..  which Interferon, Imiquimod, Zadaxin, and GcMaf are..

I am reading now about GcMaf that Stefano takes.. This is very promising route to go.

Then Murclydex and Rep9AC protease inhibitors - should do much better then nucs.

So I think this is what the researchers should be focusing on and doctors. Rather then doing antivirals for long. If you worry about resistance take Truvada, Three drugs that will really suppress HBV.