one yr on adefovir
three yrs on entecavir (as virus got resistant to adefovir )
my recent results were - hbeag positive ( which was negative for four yrs)
anti hbeag positive
hbv dna < 20
hbsag 250 iu/ml
i consider the use of tenofovir plus entecavir because you do have adefovir resistance which reduces response to tenofovir
but i was on entecavir for last three yrs is it ok if i continue entecavir plus tenofovoir from this point...as i need to plan for babies too...i heard its not safe to use tabs while u r pregnant :-(...doc was saying as u plan to have babies if interferon works that would be a plus point and that if after three months we find it not working we can immediately withdraw the interferon injections and will give me tenofir which is safe during pregnancy...i am a lot confused plij suggest what shall i ask my doc to do?...:-(
it is also interesting to note:
me and my sister got infected from my mother who had wild type all life (hbeag reversion many times) while my hbv mutated to precore and bcp plus q215s very early
my sister has also precore or bcp because she turned immune tollerant again for few months when on alinia monotherapy but hbeag stayed negative without reversion
hbeag is produced similar to hbsag, indipendently from virions (hbvdna).this in wild type and you can have hbeag pos, hbeag neg with hbeab pos and both negative if antibodies and antigenes are in balance
remember that you can be hbvdna und but no decrease of hbeag
with the precore bcp the hbeag is reduced or not produced so any hbeab is ble to hide hbeag in blood
the easiest thing is follow hbsag quantity when it reaches values less than 1000iu/ml for genotype d the hbv virus is really inactive and it is very difficult to have both hbvdna high again or hbeag reversion
In one Taiwan study, 283 patients were followed for a median period of 8.6 years after HBeAg seroconversion, 4.2% had HBsAg reversion. I have a feeling that these occurred in the immediate period after seroconversion. It is hard to understand HBeAg reversion in the setting of very low hbvdna.
another important test is precore/bcp mutants test, adefovir, lamivudine and entecavir mutants test and genotype test
if you have no precore/bcp mutants your hbeag positive status will have 16% hbv clearance with the use of tenofovir plus entecavir, 24% tenofovir plus entecavir plus interferon.i consider the use of tenofovir plus entecavir because you do have adefovir resistance which reduces response to tenofovir