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Chronic HepB Case (Please help)
May 22, 2005

In my previous question, you suggested that the response with Adefovir is slow in my case and I should consider Entecvir. I have completed 6 months of Adefovir treatment, but normal treatment duration is 12 months. Should I stop Adefovir treatment and start Entecvir right away or should I wait for another 6 months to finish the Adefovir treatment and then consider Entecvir?

If I start Entecvir and if Entecvir brings down my viral load to undetectable level, can I discontine Entecvir and start Adefovir? I am concerned about viral resistance with prolonged use of Enrecvir.

Here are my lab results.

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.

Thanks for your very valuable help.

Response from Dr. McGovern

You have good options open to you. Just this week there was a GI conference that had more information about adefovir that demonstrated that over time (3 year data)more and more patients became HBeAntigen negative. This is good news because E antigen seroconversion is one of the main goals of treatment. Also resistance rates with adefovir are low and slow to emerge.

Entecavir resistance has been reported in patients who have had lamivudine resistance in the past. If that is the case with you, that is an important consideration. We do not know enough about the emergence of resistance with long term use of entecavir; that information will emerge over time with use of the drug.

What we don't know enough about at this time is the role of combination therapies, particularly in delaying resistance.

You could finish the next six months of adefovir and see how things go since you are achieving lower levels of viremia - albeit slowly; the other consideration is if you are feeling well on adefovir you also may want to continue the same drug. Entecavir is just another option you can speak with your physician about. It has the potency of dropping viremia faster than other medications, but its eAntigen seroconversion rates are similiar to lamivudine, to which it has been compared.

Dr. McGovern



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