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Avatar universal

Truvada for Hep B treatment questions

I'll start 1st by saying I'm a gay male who sought out Truvada as PrEp as a way to further eliminating my risk of HIV. Late October 2015 I sought out an infectious disease Dr who was knowledgeable of Truvada as Prep. Prior to him giving  a prescription I was required to have a full blood panel along with a HIV test also screened for Hepatitis. This is when I discovered I was Infected with Chronic HBV. I had elevated alt & ast as well as a viral load in the millions. Upon diagnosis I was ordered to have an ultrasound which showed I have some fat on my liver. I was a daily drinker 1-2 drinks per day for many years. Since I was diagnosed I have all but quit drinking except for a few occasions in the past 2 months.

My Dr has been very involved on checks on me regularly and I feel comfortable with him. He recommended I begin to take Truvada for HBV treatment which I have been taking for 2.5 months. ( I also consulted with a Hepatologist who agreed with the treatment plan) since then I have had my liver enzyme tested regularly next week I will have a full panel again checking my viral load.

My question is since I've been on Truvada my Alt and Ast have been very high. My Dr seems to think that it's due to my body reacting to  Truvada and the replication of the virus. Has any one else experienced this? Also could you share your experience, results, time frames etc... I would appreciate any info you could share

Here is a snapshot of my results


October 25th 2015

Component Standard Range Your Value Flag
BLOOD-UREA NITROGEN 6 - 23 mg/dL 13
BLOOD-SODIUM 136 - 145 mmol/L 138
BLOOD-POTASSIUM 3.4 - 5.1 mmol/L 4.4
CHLORIDE 98 - 107 mmol/L 98
ANION GAP 7 - 14 18 H
bicarbonate 22 - 32 mmol/L 22
Blood Glucose 65 - 99 mg/dL 83
Creatinine 0.70 - 1.30 mg/dL 0.82
EGFR >60
ALBUMIN 3.5 - 5.2 g/dL 4.8
PROTEIN 6.1 - 8.2 g/dL 7.9
BLOOD CALCIUM 8.6 - 10.2 mg/dL 9.4
ALKALINE PHOSPHATASE 40 - 129 U/L 75
AST 10 - 40 U/L 70 H
BILIRUBIN, TOTAL 0.2 - 1.2 mg/dL 0.5
ALT 8 - 41 U/L 112 H




Name
Standard Range
                            11/5/15 12/16/15 12/23/15 1/13/16

ALK PHOSPHATASE
45 - 117 Units/L
76 93 84 78
ANION GAP
10 - 20 mmol/L
13
AST/SGOT
89
>90
GFR Estimate, Non African American
>89
>90
GLOBULIN
2.0 - 4.0 g/dL
3.4
Glucose
65 - 99 mg/dL
115 H
ALT/SGPT
<79 Units/L
134 H 415 H 364 H 372 H
Potassium
3.4 - 5.1 mmol/L
4.0
Sodium
135 - 145 mmol/L
140
TOTAL PROTEIN
6.4 - 8.2 g/dL
7.3 7.1 7.1 7.1
TOTAL BILIRUBIN
0.2 - 1.0 mg/dL
14 Responses
Avatar universal
From which planet are these doctors from?truvada is not approved for hbv and just adds kidneys toxicity to tenofovir for nothing,tenofovir or entecavir are the drugsfor hbv

Taking a drug to prevent an infection while there arethousands if not more potential infections is not smart, just use a condom which prevents so many more infections without worsening health
1 Comments
I agree with your comments about condoms preventing other infections. I do use condoms.  Truvada seemed like a good option for maximizing protection against Hiv. Yes, There are additional risks to being on Truvada that's why regular follow up is mandatory or the prescription will not be refilled.

   In my situation had it not been for seeking Truvada I would not have discovered my hep b infection due to all the test that are required prior to a prescription being written. Once I was tested & discovered my hep b infection I wanted a second opinion if I should take Truvada. That's why I visited a Hepatologist the same week affiliated with another medical center. She is a transplant specialist therefore I felt reassured with her also stating it was a safer  medication that offered very good results for lowering a very high viral load quickly with low mutation risk. Her concern was if I didn't get the viral load and enzymes under control I was at very high risk for liver cancer.
Avatar universal
This is my opinion but truvada is not hbv approved because the toxicity vs benefits are worst than tdf or etv
Avatar universal
Truvada is not hbv approved, because Gilead never performed the large trial that is necessary to achieve approval.
Truvada is TDF +FTC.  FTC is identical with lamivudine except that a fluor atom was added to the ring.
the combo was shown to have substantial more hbv suppressing power due to some peculiar synergy mechanisms.
it is now the drug of choice for patients that show a reduced response to TDF presumably due to some partial mild resistance mutations. The alternative is  the combo TDF plus entecavir. It is hard to say which works better in this situation, but FTC does not introduce permanent mutations into mitochondria while entecavir is principally capable of doing that.

It is indeed surprising that a drug was approved as an infection prevention. It must be that at least by the formal criteria Truvada had such mild side effects that such an approval was possible. I agree that there are certainly less toxic ways to prevent sexually mediated infections.
Avatar universal
it is not clear when was the last time your measured your ALT/AST.
Can you summarise only your ALT and AST results in a more clear format.
1 Comments
1st reading is pre treatment each is one month apart.
ALT/SGPT
Units/L
134   415   364  372

AST/SGOT
Units/L
51   143   125    120  
Avatar universal
I guess one would expect ALT and AST to go down by now.
From my limited knowledge I could assume that your immune system got activated due to sudden reduction of virus in you.

Take another measurment of DNA...by now it should be lower then the pre-treatment value (which was in millions).
If your ALT and AST don't go down on the next measurement you could also get a second opinion from another doctor as to why that is the case. Try to find someone experienced (usually doctors in bigger hospitals are more knowledgable).

As you are a gay male I would advise you not to have random sexual partners because i have read that gay males have drastically greater prevalence Hepatitis D. You don't want to be catching Hep D (or HIV) on the top of Hep B, and nothing (including Truvada) can't prevent you from Hep D which usually kills those infected with it 5-10 years after one is infected, and is a much bigger concern to you then HIV at this point.
If fact I would advise you practicing sex abstinence by mastrubation when your sexual desires arise.
1 Comments
Thanks for your thoughts. I'm scheduled this Wednesday to have my viral load checked.

Both Drs I'm currently seeing are both affiliated with the largest  hospitals in the area. One is a  infectious disease specialist and the other is a Hepatologist who also specializes in transplants.

In the US hep d has a very low rate of infection nonetheless I will be very cautious as you recommended it's truly not worth the risk to be coinfected.
Avatar universal
Forgot to mention: there is no effective medicine for the treatment of Hep D, unfortunately.
Avatar universal
Phase 2 clinical trial for Hepatitis D treatment:
Eiger Bio completes enrollment in mid-stage study of lonafarnib in hepatitis D

http://seekingalpha.com/news/3038186-eiger-bio-completes-enrollment-mid-stage-study-lonafarnib-hepatitis-d
Avatar universal
hep D is rare worldwide and usually chronic if taken with hbv at first infection but usually cleared if taken later on, the point is it is so heavy on the liver and cannot be blocked, it is very infective but i guess a condom would be enough

researchers in pisa (one of the most advanced researchers in the world) told me to pay high attention to dentists only and to be the first patient of the day because hdv can be easily spread in the air and reinfect at the dentists.

Avatar universal
Actually it is reverse, hep d usually clears if one gets infected at the same time with hep b and hep D, and stays chronic if one gets it on the top of the allready present (estabilished) hep B chronic infection.

Thanks for sharing the advice from pisa researchers.
Avatar universal
p.s. advices such as this related to the dentist should be made a sticky, visible to all forum posters who register now or 3 years from now...unfortunately they get lost on the medhelp implementation of the forum once the topic becomes inactive.
Avatar universal
I just noticed I had a typo in my posts with stating my viral load pretreatment being in the millions. My original results were
Hepatitis B Quant >1000000000 IUnits/mL
LOG 10 HBV DNA >9.00 IUnits/mL
Avatar universal
no i meant you get hbv and hdv at birth, when older even if hbv is present hdv is cleared, we also have a member here with cleared hdv and chronic hbv but again it is so rare that studies are so few who knows how really reliable

while hbv+hdv is cleared as adults and not infective at all without hbv
Avatar universal
hbvdna doesn t matter its cleared by tdf or etv whatever and the highest the less liver damage because immune tolerant, remember its our immune system to damage the liver, not hbv
1 Comments
I have read that is the case as long as Ast and alt are in normal range. So it could be the case that my original alt and Ast where elevated due to other factors other than Hbv? Is it possible Treatment could have been postponed if it was immune tolerant?
Avatar universal
Your original elevations of ALT and AST were 99% caused by hepatitis
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