to stevenNYer and HR about combo tx

[stef2011]

i am checking all pros and cons about entecavir/tenofovir combo vs entecavir mono for me and in general for all.
i am probably in cirrhosis or early cirrhosis and doctor put me in etecavir mono because of tenofovir kidney problems and possible discontinuation of tx but:
checking tenofovir trials on hbv only (no hiv coinfection) kidney problems are in less than 1% patients and i haven't found tx discontinuation because of kidney problems.
hbv has no mutations at all under tenofovir tx and i think we can find data from some patients using tenofovir for more than 3 years even if not on trial about this.

entecavir mono has only 1.2% resistance but has several hbv mutations anyway altough only 1.2% has resistance to entecavir.Can this mutated hbv virus be dangerous also to your family?especially if you have a mother with liver transplant, a sister with same CHB as you and a father with hbv vaccine?

finally entecavir 0,5mg/day plus tenofovir 245mg/day has had no kidney problems at all on trials for cirrhosis or cirrhosis plus viral resistance patients.

can you also confirm what i have found on trials?if all this is true it would be very stupid to go on with entecavir mono or any mono tx for all patients?is it all a matter of money as HR says?

thank you

[stef2011]

if you find links or just documents online about entecavir/tenofovir combo please link them on forum.
resistance is what i am more worried and since i have never had kidneys problems i don't understand the point of view of my doctor on kidneys, maybe he knows about new trial results or maybe he is wrongly considering hiv trials.HR is probably more experienced on this issue

[stevenNYer]

The mechanism for resistance is differ from antiviral to antiviral.  For example, Lamivudine resistance is more on and off.  Adefovir is more gradual.  Unless you research this area, it's hard to know what exactly is happening.  But we do know all antivirals are at risk for resistance over time.  And since you are 40 with early cirrohsis, you need the antiviral to stay working for another 30 years or so without resistance, that is a tough goal.  So resistance is much more a concern that current documented sides.  

The argument for monotherapy right now is that it can get you to UND just like combo.  But below the UND (actual) numbers, combo still hold viral count lower.  Now some may say that's nothing but maybe not.  Maybe that slighty higher viral load (though still UND) puts you at a giher risk for resistance.  Another important thing si that there is strong evidence that combo therapy reduces the risk for resistance.  Even Lamivudine and Adefovir combotherapy buys a person much more time in treatment without DNA rebound.  We are just applying the same reasoning to the newer more powerful antivirals.