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Chronic Hep B case _ Please please help.
Aug 5, 2005

Dear Doctor,

I have chronic HepB. For the last 9 months I have been on Adefovir (10 mg). After completion of 1 year treatment I would like to know what treatment I should consider to achive undetectable HBV DNA load and eAntigen seroconversion. I heard that some people are considering Lamivudine + Adefovir. This combo treatment may help emininate the possibility of viral resistance. Other people are considering Entecvir. Can you please recommend? I had liver biopsy on 10/28/04 which showed Fibrosis stage 2 and inflammation grade 1. Here are my latest lab results.

7/25/2005 HBV DNA lOAD 5.5 or 316500 Copies/ml (LOG) or 1584893 AST = 27 (0 TO 35) ALT = 30 (0 TO 55) Total Protein = 7.1 Albumin = 4.4 WBC = 3.9 RBC = 4.7 Hemoglobin = 15 Platelets = 135000 AFP = 3.6 HBeAntigen = Positive HBeAntibody = Negative

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

Your hepatitis B virus is coming down ever so slowly. Part of the problem about picking any medication is that your liver function tests are near normal so that your chance of a response to treatment is lower than in someone with abnormal liver function tests.

I would consider discussing entecavir with your physician due to its potency in viral load reduction.

Dr. McGovern



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