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Chronic Hep B - follow-up question.
Sep 25, 2005

Dear Doctor,

In my previous question below, you responded that I consider Entecvir after completing 1 year of Adefovir treatment. My question is can I take Enetecvir until the viral load is undetecteable and then switch to Adefovir? I read a recent study on Adefovir. It suggested that after an average 80 weeks of Adefovir treatment 90% of patinets were able to achieve sustained response - in other words their viral load remained undetectable 1 year after the treatment. This seems very impressive for adefovir treament. Is this true?

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.

Thanks for your very valuable help.

Response from Dr. McGovern

The longer the time on adefovir, the increased chance of becoming undetectable - that is true. However, that is for the subset of patients who stayed on the drug. Resistance also increases over time although much lower than on lamivudine (Epivir). Entecavir resistance also occurs, although so far only in patients with prior lamivudine resistance.

Your question about switching back to adefovir after obtaining a non-detectable viral load on entecavir is an interesting one - however, since there are no data on this approach I can only speculate that this may be fine, as long as you have no evidence of resistance with adefovir. Discuss this interesting question with your physician.



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