question regarding tenofovir

[varsa]

First of all thanking to all community member for educating all patient about this deaseas.my quiry is that my sister in law is suffering from chronic hbv she is on entehep 0.5 mg i want to switched her from entehep to tenofovir but i heard thai it has side effect on kidney and bone loss so how to overcome this situation. Thanks

[varsa]

What is the cost of interferon in india. And can any one tell the good hbv doctor in kolkata, thanks

[stef2011]

for most all life and death from other causes, it is just a percentage of chronic carriers to have hcc or cirrhosis after 40-50yo usually

[varsa]

Stef in my country 3 to 4 percent have hbv and some of them are very poor so what will be the average life of untreated chb patient

[varsa]

Ultrasonography for liver

[melcul]

i don't know about Usg accuracy. mine showed F2 fibrosis, and when i checked Fibroscan, was 5.6 kp (F0)

[melcul]

do not mistake Usg of Fibroscan !. you need fibroscan to check your liver every 6 months

[varsa]

Thanks a lot all community member, so the summary of chb treatment is
1. Alt/ast. 2. Hbv dna test in iu/ml 3.hbv quantity in iu/ml 4.fibroscan 5. Usg of abdomen in every six month
When hbsag quantity goes down to 1000 iu/ml hbv patient should treat with interferon to make hbsag negative.
I have checked my all family member all are hbsag non reactive they all have taken hbv vaccine. Should we need another care for hbv diseas. Thanks in advance

[stef2011]

some explanation about tests

http://www.webmd.com/a-to-z-guides/creatinine-and-creatinine-clearance

[stef2011]

so when gfr is less than 90 the kidneys are damaged already and whatever drug is taken will make more damage

[stef2011]

once again creatinine is normal in many kidneys failure patients, not reliable test

all tests are very poor for kidneys.the danger of this: when you find these tests abnormal most of the kidneys are damaged already and the very big problem is there are no tests to see damage when it is happening so you can stop it before the function is compromised

[stef2011]

your doctor was taking about creatinine and not creatinine clearance

i think you had another test

this is creatinine clearance test and its ranges
http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm

urine check must be ok, if not there are very very big problems and it has nothing to do with kidneys function i mean if you find it not ok kidneys can be gone already

[melcul]

My creatinine in 24 hours was 0,77g/24h  [1.040-2.350], complete urine exam was in limits, i ask my doctor, he said that lower is good and higher is bad. I'm confuses now

[stef2011]

the best way to measure kidney function is by checking creatinine clearance with 24hr urine collection, but since it is difficult to for many patients to make the collection correctly they did gfr by mathematical calculations from creatinine
since creatinine can be normal on some even with kidneys failure i dont like grf test too much

anyway less than 90 the kidneys are not working, at some lower values dyalisis is needed to live.my baseline tests were 108, during heptech 118, during heptech plus gcmaf 144

[luckyman316]

My kidneys were perfectly fine at my baseline. 6 months into it, they got worse on these meds. It's borderline though. Only kidney issue I had was 2012 when I had kidney stones, and that was from eating a lot of garbage foods and drinking a lot.

[melcul]

Six months ago i had 95.2 egfr, [100-170] ml/min/1,73 .is it bad to be lower or higher ?

[stef2011]

so patients with normal kidney function had an improvement whatever the nucs used, this is because hbv can infect kidneys too (but not replicate there)

those with insufficient kidneys function baseline had a worsening which is probably correlated with the kidney disease they had prior nucs start

[stef2011]

http://www.cghjournal.org/article/S1542-3565(14)01712-1/fulltext

Effect of Nucleoside and Nucleotide Analogues on Renal Function in Patients With Chronic Hepatitis B Virus Monoinfection

Background & Aims
There is controversy regarding whether nucleos(t)ide analogues contribute to renal impairment in patients with chronic hepatitis B virus (HBV) infection. We analyzed changes in renal function in patients with chronic HBV infection and whether these were associated with treatment or comorbidities.

Methods
We performed a longitudinal observational study to investigate factors associated with renal function in 214 patients (median age, 43 y; 69.2% men) with compensated chronic HBV monoinfection treated with 343 lines of nucleos(t)ide analogues (210 monotherapies, 133 combinations) between 1990 and 2012 (median time, 2.4 y) in France. A linear mixed-effect model was used to model variations of estimated glomerular filtration rate (eGFR, computed with the Chronic Kidney Disease Epidemiology Collaboration formula), adjusting for age, sex, geographic origin, initial liver fibrosis, level of HBV DNA, and an eGFR less than 90 mL/min/1.73 m2.

Results
The eGFR decreased in patients given adefovir dipivoxil as monotherapy or in a combination (P < .0001 and P < .002, respectively), and remained stable in patients given lamivudine, tenofovir disoproxil fumarate, or entecavir. The eGFR decreased in patients with a baseline eGFR of less than 90 mL/min/1.73 m2, regardless of treatment. The eGFR remained stable or increased, regardless of treatment, in patients with a baseline eGFR of 90 mL/min/1.73 m2 or greater and with an initial HBV DNA level of 100,000 IU/mL or greater. Patients born in areas of high endemicity of HBV were more prone to increases in eGFR with treatment.

Conclusions
In a real-life study, the eGFR remained stable or increased over time in patients with chronic HBV monoinfection with a baseline eGFR of 90 mL/min/1.73 m2 or higher and treated with tenofovir disoproxil fumarate or entecavir. Patients born in an area of high endemicity of HBV who had initial levels of HBV DNA of 100,000 IU/mL or greater were more likely to have an increased eGFR with treatment.

[stef2011]

it is 50%, typed 505 by mistake

check older posts, the study is already posted few weeks ago

[Kamranbey]

Stef, what is the total number of samples including these 505 patients?

[flyinsky]

Versa fibroscan is vert important test it showsif the liver is damaging or no and according to fibroscan alat ASAT viral lload and every test related to liver,a treatment is imposed or not.and if she is under treatment she should to do hbsag UI to see if there is a decrease or not

[Kamranbey]

Luckyman, sorry to hear that you got side effects from Tenofovir. All these four years, I have very low VitD25oh (around 13-15ng/ml). I never used VitD suppliments (thanks to my CARING doctor). I should be the most vulnerable for kidney and  bone loss effects. Maybe I'm the lucky one. One thing I have to mention is that I always take Tenofovir just after breakfast. I don't smoke, and I don't drink alcohol, I do a lot of sport.

In any case, tenefovir has not been very successful with me, I'm finally coming close to HBVdna undetected.  

[varsa]

Her hbvdna is undetectable now

[varsa]

Thank you sir for sharing your experience i  regular follow stef and othef community member from 2 year. My sister in law name versa suffering from chronic hbv i dont know how she got infacted she has one doughter and one son both are nbsag negative may be this happen as she is nbeag negative due to this. During the first treatment her hbv dna lvl was 1200iu/ml and small rise of alt lvl than normal but after 6 month it turn to 2200 iu/ml then doctor orderd entehep 0.5 for her for five year.from this forum i knew that chb patient should watch othef test like fibroscan, alt hbv dna and hbv quantity for treatment, but doctor dont order this treatment i am confused what to do. Please help. We all family member have taken vaccine. Thanks in advance

[luckyman316]

Varsa, the advice on this board as been great. Please listen to the members here, they are talking from experience. Everything they have suggested for me, has helped.

Now, I want to go back to something here. I, unfortunately, am one of the members who are seeing problems with my kidney functions going down and also bone loss while on Tenofovir. When I started, my Vitamin D levels were at 76ng/ml  so I ended up increasing my Vitamin D3 intake to 20,000iu. I should find out this week what the latest is after 8 months, but there was bone loss when even on that. It's documented from my "baseline" test from 6 months ago and I now have "osteopenia".  I don't have HIV and I don't do any other drugs, and eat very well. As someone mentioned here, it varies from person to person...Also, something I think Stef forgot to mention is to take Vitamin K2 as well.

I don't want to scare you with this though. From what I see on here, Tenofovir is very well tolerated among  all others so it is a safe drug to take. You should see undetectable levels within 8 months, but once undetected you're body is still not clear until seroconversion happens. Stef is your best source here, do some research on his posts as to what helps.