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Fear of HB Treatment
May 14, 2005

Thank you for responding to my last question (HBV DNA - Please Help).

A quick background info, I'm asian and have been a chronic HepB since I was really young. About 30 years of age now. My ALT level has been fluctuating (63 to 75) in the last 3 months. My DNA viral load is about 30M copies. I am HBeAntigen +.

My question is in regards to treatment. My doctor, who runs the Jade Ribbon program (that promotes HepB awareness here in the Bay Area), has advised me to be on medication to bring down my ALT level and viral load. This will be my first medication and the weapon of choice is the Entecavir.

I am especially concern about the Entecavir approach because: a) Too new (FDA approved in 4/1/05) b) Not much long term data on virus mutation c) Lifetime dependent on the pill

Based on your experience, are these concerns valid? At the same time, what is the indicator to stop treatment (is it when my HBeAntigen turns "-")?

I am also so tempted to delay medication for about 3 months - while I get myself on Milk Thistle. Thought I take another test 3 months from now and find out if it actually helps, given that my condition is in the "immunotolerant phase". Please let me know what you think of this approach.

Apologize for the lengthy question. Thank you very much in advance for your help and time. Just to let you know, you guys are doing a great service to folks like us. Thank you, Thank you, Thank you.Looking forward to your prompt response.

Response from Dr. McGovern

It does appear that you are in the immunotolerant phase with high HBV DNA levels yet minimal elevations of liver function tests.

I think a liver biopsy would be very helpful to stage your disease.

I think entecavir appears to be an excellent drug in terms of reducing viral load. Your physician will be following your E antigen to see if seroconversion occurs and also your DNA level. If E antigen seroconversion occurs, some hepatologists will treat for six more months after that event based on data with other drugs (lamivudine).

I think waiting 3 months is okay since this is a chronic disease. It would be important to check your liver function tests again at the time you start therapy.

So far resistance to entecavir has not occurred in patients who do not have a history of lamivudine resistance. This may change over time. You are right to be cautious about new drugs in general.

I would definitely let your PMD know that you want to try milk thistle.

Good luck!

Dr. McGovern



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