Dr. McGovern:Thank you for your expedient and supportive reply to my question concerning Hepsera side effects. I have suffered from fatigue and malaise since contracting hepB 18 years ago. I have had normal enzyme levels and low but detectable DNA with PCR. Recent biopsy was very favorable and consistent with pre-interferon biopsy15 yrs. ago. I started hepsera a year ago to help with fatigue and malaise, but Ihave felt worse in spite of undetectable DNA.I terminated treatment just 3 days ago after consultation with my physician. Is there any expected complication from the serious "spike" on the warning label, or can I expect levels to return to pre-treatment normalcy in time? Two physicians I consulted have no knowledge and I suspect you have more research experience and knowledge on the matter. Thank you again for your time and support. I just found this forum and it is quite valuable and helpful to others as well, I'm sure.

The "spike" which you refer to can actually occur with other hepatitis B drugs like lamivudine also. This can be related to suppression of hepatitis B virus while on therapy which is then followed by a large "rebound" of virus when therapy is stopped.

You should definitely have follow-up liver function tests to be certain that this does not occur. It only happens in a minority of patients and I suspect that you will not be at risk because of your prior history.

Dr. McGovern