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Avatar universal

Reduced dose TDF

StephenCastlecrag / Stef2001 / anyone....
Please help me with your input understand if what I'm thinking is dangerous, so little data and studies I could find. Gilead must've tested various doses of TDF during trials before releasing it but no data published and available from them on effect of different dosing..

Planning on reducing current daily dose of TDF 300mg to 150mg daily or to 300mg every other day in an attempt to lower the possible damage kidneys and to slow down damage to bones (osteoporosis started), and perhaps less chance for lactic acidosis.

Background:

Was on Lam for 13 years (last 3 years of which in combination with Adefovir), both were stopped followed by near death  acute flare up and TDF was started. On TDF mono therapy since then and continuing.
Already 15 years of TDF 300mg every day.

Previous Nucs caused mutations (as of 2008): N236T, A181V, M204I, M204V and L180M.

I am 68, HBsAg-pos HBsAb-neg, ALT-good(22), DNA-undetectable,  HBsAg- pos,quantity N/A,  Fibroscan-7.4Kpa, Vit.D3- 5000IU daily and 10000 daily in Winter (50ng in blood), HBV genotype-N/A.

Would like to ask:
1. Am I right to consider TDF dose reduction to 150mg a day?
2. Could "weaker" dose have less impact on the virus and allow it to "gain strength" in replication or something  else?
3. Could it also make it easier for the virus to produce mutations?
4. Could it help the existing mutations from previous Nucs exposure "wake up" and escape the suppression TDF had on them while on full (300mg) dose.

Will be most grateful for your opinions,
Regards and be blessed, Peter

Best Answer
Avatar universal
Sorry to hear that you made a typo and is not HBsAg negative. My answers are substantially the same, but of course, I would suggest more caution and closer supervision by your doctor in whatever you decide to do.
I may suggest that you consider stopping your HBV medication. This may lead to HbsAg negative, or HBV inactive(hbvdna < 2,000 IU/ml, ALT normal, no medication), or a rebound in hbvdna and need to resume TDF. This should be done only under the close supervision of an experienced liver specialist. A quantitative assay for your serum HBsAg may guide your decision.

According to your reply to Melcul, I don't see why you should worry about your kidneys right now. If you do want to change, consider Entecavir( I don't think your previous experience with Lamvidine should matter as your hbvdna is undetectable, but does require closer monitoring for possible Entecavir drug resistance), or TAF.

Just my opinions, all the best.
1 Comments
Will start with trying to have HBsAg quantified.
  
Thank you for communicating back to me, again.

Much obliged
3 Responses
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Avatar universal
I am not a doctor. I am sure I replied earlier, but my response is missing!
Briefly, I believe you met the definition of a functional cure, HBsAg positive is not necessary, and you have only mild fibrosis, not cirrhosis, so you can stop all HBV medication. Talk to your doctor.
Gilead does recommend TDF dosage reduction for patients with low creatinine clearance. See TDF Label information for details.

1. Am I right to consider TDF dose reduction to 150mg a day?
Read my opinion above and consult your doctor.

2. Could "weaker" dose have less impact on the virus and allow it to "gain strength" in replication or something  else?
In general, yes. But TDF is a very strong anti-viral, no HBV drug resistance has yet been reported. Virus replication may increase, but I doubt it will happen in your case.

3. Could it also make it easier for the virus to produce mutations?
No, the virus mutates all the time. In the case of TDF, it requires multiple mutations to happen at the same time to escape the effect of TDF.

4. Could it help the existing mutations from previous Nucs exposure "wake up" and escape the suppression TDF had on them while on full (300mg) dose.
No. I believe your old mutations do not exist anymore as they were stopped by TDS and had not persisted.

Just my opinion, all the best.
Helpful - 1
5 Comments
There is a typo in my sentence: "HBsAg is not necessary" - it should read HBsAb positivity is not necessary.
StephenCastlrcrag and everyone .

There is a typo in my original question/post!
Don't know how to edit.

Background:....."HBsAg-neg" should read "HBsAg-pos"

Immensely sorry, it was late at night and...

Will your opinion change with this correction?

Deepest respect for you for what you are doing for everyone on this forum.
Hey Docpch! Glad to see that your liver is ok. How did your kidneys perform before/after tenofovir, was there any significant change in egfr during TDF treatment?
The same, knock-on-wood.
No, this is the reason for considering lower dose (by half) of TDF daily, before there is a change
And rather quickly deteriorating BMD (bone mineral density)
Avatar universal
You have to find out your HBSag level. Get it tested. You can do the HBSag Quant test to know the level.
Helpful - 0

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