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tenofovir plus entecavir

Dear members,

I've been using tenofovir for almost four years. When I started using it, my HBV viral load is higher than 9 log. I waited until my ALT to rise (as the doctor said, immune responsive phase) to go for medication. After first three months, I had about 5 log, since then the decrease in the viral load is quite slow but consistant. Recently I got the test results that show I still have about 134 Ul/ml comparing to the result of last year 285Ul/ml. My fibroscan and ultrasound have always been normal.  ALAT 67 U/l (only indicator which is out of the normal range). I'm HBeAg positive. Now my doctor suggested me to use enticavir. Do you think it is a good idea? can you give me your thoughts why I'm such a slow responder? many thanks.
35 Responses
Avatar universal
you may also try vit d supplements to make vitd25oh 100ng/ml and intact parathormone 10-20pg/ml, this will make a strong impact on immune system by 6 months of stable levels of d and pth and tdf alone might be enough

you dont risk resistance and you may give vit d a try for few months, you must use very high doses at start to get vitd25oh at 100ng/ml, what are your levels now?

no dairies and drinking 2.5l of water daily will help get the targets and void any calcium increase, probably will lower calcium
Avatar universal
no it is a really bad idea and it looks also ignorant just trying the drugs random.gor hbeag pos with high viral load etv alone is also a pretty possible failure, int hose cases tdf or tdf+etv is suggested

the best choice is add etv to tdf and you get und in a bit
Avatar universal
Stef i think his doc want this add entecavir to tdf as I understand from the title
Avatar universal
thanks for the reply stef and flyinsky.

I have never used entecavir. flyinsky is right, what the doctor suggested was to use both tenefovir and entecavir. Can I do that? I don't wanna risk my kidney by taking several drugs. What is the reason do you think that I'm such a slow responder? I checked my VitD, and it was very  low, I mentioned that to the doctor, but she just ignored.  
Avatar universal
In my opinion try to have a second opinion of an other doc.for vit d she should give you a dose to rise it.even normal people take vit d when it is low especially if you live in country where there is no sun.is she a liver specialist?
Avatar universal
etv+tdf is good then.i was a etv non responder so i also had etv+tdf

no problem for kidneys but vitd25oh must be around 100ng/ml, kidneys work at 50% less with deficient/low vit d
Avatar universal
I did new blood test, as I didn't have vitd25oh in my last test. Here is the result: 15.2ng/ml. I have tanned skin, and here we have enough sunshine.  I do a lot of sports. I don't know how come this is so low.

Here doctors prescribe every three months of dose of vidD. 100,000 IU one shot. How can I proceed?

No dairies? do you mean no milk and cheese? that will be very difficult for me. Why no diaries? Sorry for my ignorance.

One thing I noticed in my test results:

For years ago, before taking tenofovir (two different labs in different countries):

HBe-Ag: 1366
HBs-Ag: 409

now:

HBe-Ag: 112
HBs-Ag: 1629

I'm puzzled. How come HBs-Ag increased, even though I have continuous decrease in viral load?
Avatar universal
BTW, I started to use enticavir+tenofovir from today.
Avatar universal
Can I take these two at the same time?
Avatar universal
Vitd25oh is low in all chronic diseases and all hbvers have it extremely and dangerously llw like you, that s a way pathogens use to suppress immune system

Vit d3 (not vit d2 which is snsynthetic and very bad) must be taken daily like we do naturally with the sun.big doses monthly or yearly have shown worsening of diseases because vit d must stay stable.

italian guidelines indicate one shot from 300.000 to 1.000.000iu once and then daily from 2000 to 5000iu.the best from our experience in the forum is one shot 100.000iu and then daily 10.000iu
you also need to check intact parathormone because vitd25oh alone is not able to tell you if you corrected deficiency in the tissues and if cellular vit d receptors are working or blocked

so your target is vitd25oh at least 100 ng/ml and pth 10-20pg/ml.no dairies is to take calcium low while you take vit d and because most milk is full of drugs which are fed animals like antibiotics and steroids, it also promotes cancer and our bodies are not supposed to drink cow milk all life in those quantities, we even miss some ezymes to assimilate all milk.oat milk without added calcium is best best healthy choice.

correcting this vitd25oh and pth will make your immune system work normally and boost hbv immune response, cancer responce and so on, check all studies on vitamindwiki.com it may save your life since low vit d increases risk of death of all causes
Avatar universal
There is no correlation between hbsag and hbvdna, and hbvdna in blood just means you lowered hbv replication but the liver still has virions

After about 5 years on antivirals you can try peginterferon add on to clear hbsag, test your quantity your tests are not quantitative if the unit is not iu/ml.there are only 2 machines for hbsag quant, elecsys roches or abbott architect check if the labs have the machines before doing the test.if you find hbsag less than 1000iu/ml the chances to clear by pegintf add on are 91%
Avatar universal

Many many thanks steff. Maybe you have writen about these several times here in this forum. Sorry, if I made you to repeat it. It's not easy to go through all the posts to find the answer one is looking for.

I'll follow that. Can I take Tenefovir+Enticavir+VitD at the same time?

Everymorning, I drink 250cl of cow milk . If I stop that, what should be the right diet? I eat a lot of meat, vegetable and fruit anyway.

What are the other suppliments that I should take? Vitamine C etc? Some one mentioned selenium?

Avatar universal
Entecavir must betaken empty stomach 2hrs before and 2 hrs after so best take it before bed while tdf at breakfast.it is possible totake all together but i dont think this is the best absorption way

etv befoe bed
tdf breakfast
d3 lunch or dinner
Avatar universal
Yes selenium is good from 200 to 400mcg daily, i dont remember which is the best type google " best type of selenium"

vitamin b2 helps vit d3 absorption, vit k (mk7 type) helps take calcium away from blood and fix into bones.natto is a japanese food extremely reach in mk7
Avatar universal
Thanks again stef.  

91% chance of clearance when HBsAg lower than 1000iu/ml with peg? I thought the chance is about 5%. If it is the case, it is really encouraging...

I read somewhere the chance of clearance is much higher for the patients responded in short time period for nucs. If I clear viral load in four years, I thought I had almost no chance of clearing the virus.

What are the most important quantative tests I should do to monitor the progress with both ent+tnf and all the suppliments? I'll update members with my results from now on.


Avatar universal
hbsag quant in iu/ml

check all the studies of sequential we posted and all the members that are clearing on it or cleared already


Avatar universal

stef, I read many posts, and most commonly I encounter the comment "lucky 5%".  That's why I'm surprised by this 91%. Do you have a link for this study? do you think slow responders for nucs still have as high chance for clearance? I may sounded stupid with these questions, I do admit I didn't do much research on HBV (due to family, work etc). I probably relied too much on my doctors.  
Avatar universal
it is full of posts about sequential, just go backwards or search on google sequential 100% response and 91% clearance:medhelp
Avatar universal
Got it. The target is clear for me now.

Where can I get reliable VitD3? I see on the internet, there are many types, but most of them are low doses. I don't wanna take several pills. Who knows what else they have inside. Can you suggest me an internet site, where they have 10,000 iu dose in one pill or two? I'm in France.

Avatar universal
bonjour
il faut bien demandé l avis de votre médecin traitant ou ton hépatologue  . pour moi j avais des douleurs articulaires et quand j ai fais une prise de sang pour la vitamine d le resultat etais de 17ui donc sous la norme, mon médecin traitant m as prescrit une dose de 1million ui ,une ampoule chaque mois pour trois mois,apres j ai refait la ps et le taux du vit d est normal et maintenant je prend une ampoule de 100.000ui/ml chaque trois mois et je vérifié a chaque 3 mois la dose du la  vit d qui est  tjr normal .ev évitez l achat par internet il y as tjr des fraudeurs
Avatar universal
hello
it must be requested by your doctor or your hepatologist . for me I'd joint pain and when I 'm doing a blood test for vitamin d the result was  17ui therefore under the standard, my doctor prescribed a dose as  1million ui , ampoule every month for three months, after I have redone the check and the rate of  vit d was normal  and now I take  100.000ui / ml every three months and I have checked every 3 months the dose of vit d which is normal  . avoid the purchase by  internet there have always fraudsters
Avatar universal

Merci flyinsky.

It would be nice if I can maintain normal to high level of VitD25oh with your recepie. I'm not sure if the doctor will agree to prescribe me such a high dose for the first three months. After you start using 100,000 ui  every three months, I'm wondering, if your test was done at the end of the three months or shortly after you take the shot? What I mean is can the level be stable during the three months, before you take another shot?  

Avatar universal
it doesn t work taking big doses once because both vitd25oh and pth will be unstable and this may do more damage than good and this is what trial showed.this is very unnatural

the natural way is taking the dose everyday and usually 10.000iu of d3 is ok to keep vitd25oh 100ng/ml and pth less than 20pg/ml.again it is all different person to person, you just have to take the test every month

but if vitd25oh is less than 10ng/ml a very high dose to start is mandatory, guidelines require 300.000 to 1.000.000iu in this case
Avatar universal
Is it good thing that I have high ALT (it is always around 60  to 120) all these four years? does it mean I'm killing the infected cells?

Another confusion I have is why HBeAg negative patients respond less for medication than HBeAg positive patients? For me positive means the virus is replicating, so it should be more difficult to clear the virus, isn't it?



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