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LAM vs. Adefovir (without Liver Biopsy)
May 11, 2002

Dear Doctors,

I lost my job and don't have health insurance. I went to the local clinic and they sent me to the local hospital. The GI doctor can only see me once a month. I am surprised he recommended IFN without having a liver Biopsy. I was diagnosed 18 months ago. I am HBeAg Pos, HBsAg Pos, HBcoreAB Pos, HBsAB Neg, HBvDNA Pos, 187 X 10(6) copies.

PTLS are low : 122 K/Ul AST 126 ALT 276

How can I have access to a doctor willing to go through the paperwork and protocols to get Adefovir for me?

Is Entecavir any better than Adefovir?

If I enroll in a clnical trial (double blinded) of Entecavir vs. LAM, would it be a good move knowing that LAM after a year ( I am guessing) may cause virus mutation?

Thanks a lot.

(I am so concerned.. my right hand side - abdomen is hurting, and I don't know if it is smart to wait until Adefovir is released).

Thanks.

Response from Dr. Fried

Liver biopsy is important for understanding the current stage and prognosis of your hepatitis B. Physical exam and x-ray studies could indicate if cirrhosis has developed but it is not as sensitive as liver biopsy in early stages of cirrhosis. Given the description of your blood tests, it appears that treatment is indicated.

Both drugs licensed for HBV, interferon and lamivudine, have merit and the choice of agents should be made after a discussion betwen you and your healthcare provider. Adefovir is not available except in a clinical trial or through an expanded access program in those who developed resistance to lamivudine.

Participation in clinical trials is important because it is the only way we can advance the treatment of these diseases. However, whether a clinical trial is right for you depends upon the study design, the drugs to be tested, and your comfort level at not having a choice of therapy in a randomized trial. Again, this must be discussed with the investigator so you can make an informed choice.



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