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HBV viral load went down and now it seems to go up.
Sep 23, 2002

Dear Dr. Dieterich,

I have an update on my case (Chronic HBV, e-antigen positive)

It seems that my viral load went from

(1)260.000.000 (Nov.2000) TO (2)186.780.000 (Apr.2002 without any treatment) TO (3) 41.700 (Ago.2002 after 2.5 months with LAM - Tests practiced overseas. "COBAS AMPLICOR HBV MONITOR TEST, sensitivity 200- 200,000 copies/ml") TO (4)141.500 (Sept.2002 after 3.0 months with LAM)

For the same dates:

ALT: (1)180, (2)318, (3)184, (4)156

AST: (1)62, (2)147, (3)85, (4)65

Should I be concerned for currently having an increase in the viral load (over 3 times the August's results) even knowing that each lab and even each week your test results may different, even more being in another country? I am still trying to find out with the last lab what technique they used.

I just wanted to share my results with you and ask for your opinion. The new doctor seeing me in the US recommends to stop immediately LAM (he mentioned that less than 5 of cases with LAM reach e-antigen sustained seroconversion, and the risk of developing YMMDD increases on the 6th month. I have read that the success rate is about 33, but don't know the numbers for sustainability after seroconversion... The doctor in my country says LAM is working and we should give it a chance until December (7.5 months of treatment).

Thanks for your kind word of advice.

Response from Dr. Dieterich

Tough decision. Sounds as though the virus is escaping from control. However, there is no reason to panic. The resistant virus is less fit than the wild type and there are now drugs available like adefovir and tenofovir that can treat LAM resistant HBV easily. Good luck! DTD



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