First of all, not all hbvers require immediate treatment, sometimes it is not necessary to treat but simply to monitor. If treatment is needed, the first choice is Pegylated Interferon, a 48 week course of once weekly injection. The other two first-line drugs are Tenofovir and Entecavir, both a daily pill of at least several years duration treatment. For the more adventurous, treatment will consist of combination treatment with PEG IFN with TDF or ETV in various sequence, add-on, mono/combo combinations.
What is adventurous today, maybe passe to-morrow. I once saw a TV program of a surgeon doing a lung transplant. I think there were only two persons, including the surgeon, excluding the patient, in the theater.
Drugs like Entecavir and Tenofovir will inhibit the replication of virus, hence reduce viral load and this should normalize ALT, reducing inflammation and prevent fibrosis. This is the most important reason for taking Entecavir/Tenovir. Certainly, most patients who take Entecavir will also seroconvert their eAg after a period of time of treatment. This may serve as an endpoint of treatment after 3 consecutive test results of undetectable hbvdna.
As to whether Entecavir directly cause HBeAg seroconversion, I am not so sure (just my personal view). I feel there are other host and viral factors at play.
if ever i take entecavir and seroconvert my hbeag?can i stop taking this antiviral right away?
is there a chance of getting resistance with the drug and reactivation flare if stop taking it?...
what is the correct step when stopping it?
You asked very good questions. I don't know the answers. Generally, stopping can be considered after 3 consecutive (6 months apart?) tests showing undetectable viral load. I must add, researchers from Taiwan support stopping with close monitoring after stopping, but European researchers said they don't stop. So there is no uniform agreement, may be more research with HBsAg level as an indicator may identify a valid stopping rule.
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