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Chronic hepB Case (Please Help)
May 14, 2005

Dear Doctor,

I have chronic HepB. For the last 6 months I have on Adefovir (10 mg). Here are my latest lab results.

5/4/2005 HBV DNA lOAD 6.2 (LOG) or 1584893 AST = 29 (0 TO 35) ALT = 37 (0 TO 55) Total Protein = 7.1 Albumin = 4.4 WBC = 3.9 RBC = 4.7 Hemoglobin = 15 Platelets = 135000 AFP = 3.0 HBeAntigen = Positive HBeAntibody = Negative

2/2/2005 HBV DNA lOAD 6.5 (LOG) or 3162277 copies (?) AST = 35 (0 TO 35) ALT = 44 (0 TO 55) Albumin = 4.4 HBeAntigen = Positive HBeAntibody = Negative

11/15/2004

AFP = 5.2 WBC = 4.0 RBC = 4.91 Hemoglobin = 15.9

10/20/2004

HBV DNA lOAD 8.1 (LOG) or 125892541 copies (?) AST = 37 (0 TO 35) ALT = 52 (0 TO 55) Albumin = 4.4 HBeAntigen = Positive HBeAntibody = Negative Fibrosis Stage 2 Inflammation Grade 1

9/28/2004 ALT = 52 AST = 37 Ultrasound = Normal I had acute Hepatitis in June 2002 but did not start the treatment until 10/20/2004.

I would like to know your opinon if the Adefovir is going to work for me. I still have some pain in my back rib. I do not know when it will subside. Is there any thing in the diet that I should consider to help subside the pain? The pain is on and off it is sometimes there and sometimes it is not. I also get tired very easily. Is there anything that I can do to improve on that? The Adefovir treament has brought down the viral load but I still have some pain in my back ribs every now and then.

Please help us the progress.

Thanks for your very valuable help.

Response from Dr. McGovern

You have chronic hepatitis B with an E antigen positive status. I think you are having a viral load response with adefovir but it is slow.

There are other drugs which can also be considered such as entecavir, which has a potent effect on viral load suppression.

As for your rib pain, I am not sure of the cause of that, and you should discuss this with your doctor. The fatigue may be from hepatitis itself; again discuss this with your doctor who may may to run other blood tests, ie thyroid testing.

Dr. McGovern



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