Why has the doctor put my brother on Viread? And Side Effects.

[miteshshah]

His doctor has been terrific. He is a liver specialist, and said that we don't want him to fall into the 1% of patients. What did the doctor mean by that?

I also did my own research, and it seems that Drugs used in hepatitis are used for Chronic Hep B (not for acute). But my brother started having clinical symptoms just a week ago, so why has the doctor put him on Medication? I am sure there is a reason for it, I was just too afraid to ask the doctor infront of my brother.

I recall the doctor saying something along the lines of: medication is to increase the inflammation, and speeding up the recovery process, so that his body can mount a good immune response to the virus. that is the reason for the medication, i believe.

So far, my brother has been finding the side effects of the medication quite tough. Especially the headaches. Any tips on how to reduce this? I know that Tylenol is out of the question.

Thanks very much. This is quite stressful!

[veteranB]

You also have to keep this in mind. Same class of drugs that are used to treat hbv and hiv. Are also given to people after high risk exposures. To stop HIV.

And TDF does stop HIV if given within 72 hours after exposure. They did studies in Brazil.

So you may all later thank your brothers doctor for being at least aware on what to do.

[veteranB]

Well your brother is lucky to find a knowladgeble doctor. With me they just let me walk around with acute hbv. And here I am in the one percent of the unlucky once  

Treating is always good. But in your brothers case of acute hbv interferon works better.

In the old days in Russia people with acute hbv were hospitalized for up to three months given interferon with high doses of vitamins and minerals. Everything was done to prevent hbv from taking control over the immune system.

Maybe Viread alone can work. Ideally it should. Keep us posted.

[jebi77]

HI guys, thank you for the post and replies. My mother has been diagnosed with hep b(only) and her initial liver enzymes were ALT 110 and AST 65. Second week it came down a bit but then kept getting higher. In fourth week she became so ill that I had to take her to ER and they found that her electrolytes were extremely low so after four days of IV fluid and insulin shots(she is type2 Diabetic) she was released. One week later she was put on viread and has been taking it for almost a month. Her ALT and AST are now in 1000+. Her liver specialist is not sure why !
(she was negative for all other Hepatitis and HIV)

Last blood report showed that her electrolytes are back to normal but enzymes keep going higher. I am confused....
any thought

[stef2011]

hbv and hcv are called silent killers, they kill with no symthoms, so do not relay on sympthoms at all, when they happen you are usually close to death.your brother still has symthoms even after taking such potent antivirals......so:
1 take blood tests and relay only on them
2 just let the doctor manage recovery

at 99% your brother was at risk of death due to excess of immune response, he may still be, so just follow docotrs advice.while normal acute hbv is nothing serious, fulminant hbv is extremely dangerous.after all even if it was acute hbv he is going to clear it faster by antivirals with less liver damage

[miteshshah]

i just feel that fulminant hepatitis b seems to be out of the picture altogether. i mean, fulminant hepatitis sounds serious, as it progresses to death. but my brother has been discharged, and now just has to follow up in the clinic. no more hospital stays.

he still has cramps in his stomach, and some nasea/vommiting, but its improving day by day. wouldn't these be good signs of recovery, and improvement?

[studyforhope]

A fulminant hepatitis  B never leads to chronic Hepatitis, but often leads to death. Since the activity and intensity of the immune attack on the liver is partially fueled by the amount of circulating virions, his hepatologist wanted to reduce this factor to give him a better chance. His clinical problems are caused by the intense hepatitis, not the antiviral medication.

[miteshshah]

thanks stef. my brother has been discharged, and is now at home with us.

he's actually now only on ONE medication, and that is Viread, to be taken in the evening. he's also been given zophran for nasea/vommiting that he gets.

i think the nausea/vommiting could be due to the hep b?

he has a follow up appointment with the liver specialist on Monday. i do feel a little lost in all this, because i feel there are too many unanswered questions.  for instance, how will we know he fully recovers? how long will it take?

what are the risks for chronic or fullminant hepatitis? from what i know, he has a 90% complete recovery chance. that is good, right? but i'm still confused, why does he need medication, if this is acute? and why do the doctors seem to be so positive, despite the fact that he needs viread?

[stef2011]

if you have been prescribed such potent drugs it is for the fulminant hepatitis which is lethal for 1% acute infected, if they tried both drugs like entecavir and tenofovir they surely have the reasons, the symthoms are not the drugs but the liver failure due to acute hbv

i m on this combo and it makes no sides, keep your brother on the prescribed drugs and check liver function closely, taking these drugs have no sides while not taking them in case of fulminant hepatitis it is sure death in few weeks

i say it again better stay on the drugs and never forget a pill, it will be few months treatment

chronic hbv is complex, the virus makes no damage it is our immune system to make the damage, so your brother may have had a too strong immune response destroying the liver.these drugs will lower the virus and the excess of immune response

[miteshshah]

i actually forgot to mention that initially (before viread), he was on entecavir in the morning. but then later viread was added in the evening. i think once he is discharged, they will stick with just viread only. so far, this is my understanding.

the doctors provided some level of reassurance, by saying that his liver enzymes did rise high, and peak (which is what they said they wanted), and is now on its way back down. would this be a reason to stop drug therapy?

like i said, he is on entecavir in the morning right now, and i think the jaundice is the side effect of this medication. but i'm pretty sure they'll stop this once he's discharged.

i'm just praying to God that this is just an acute infection, and not something that was chronic, but reactivated somehow, or something that will not go away.

[StephenCastlecrag]

I find your description of your doctor's comment very puzzling. If he is being treated in the USA, then the doctor would follow standard guideline. ALT of 3000 is very high, maybe that is why he prescribes Viread. Bilirubin going up is because the functions of the liver are affected by the hepatitis and is not due to side effect of Viread.

[miteshshah]

thanks stephen. he's being treated in the USA. the doctor is a liver specialist, and he does seem to be very confident. but he has repeated a few times about that 1% number.

as far as the immune response is concerned, the doctor did say he was initially pleased to see his liver enzymes go up, they then did peak (at around 3000), and now they are back down to around 2000. but bilirubin has gone up, but the doctor said this was to be expected (b/c of the medication side effects???)

another thing i remember, the doctor said that the treatment protocol at this stage was the same, whether it is acute, or chronic. initially, they also thought about doing a liver biopsy. but then they opted against this, for whatever reason.

[StephenCastlecrag]

I think you did your research well. Usually. no treatment is recommended for acute Hepatitis B. There is a test to indicate whether the hepatitis is acute or chronic - it is the test for the presence of HbCAb-IGm in the blood.

Well, assuming that your brother is acute - that is only an assumption - the 1% may mean liver failure due to the acute hepatitis. But I think there would be other symptoms such as jaundice and other biological markers to indicate that possibility.
Viread is a drug to inhibit viral replication, it would certainly not "increase the inflammation". I doubt whether it would "speed up the recovery process". In fact, the liver failure is most probably due to a run away immune response.

So your doctor's explanation about prescribing Viread in the case of acute hepatitis is odd. May I ask in what country is your brother being treated.

Certainly your brother can take Tylenol to reduce the headache, but it must be straightly under the maximum daily dosage  .