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Chronic HepB (Please Please Please help)
Nov 6, 2005

I have chronic HepB. For the last 12 months I have been on Adefovir (10 mg). As you can see the viral load did not go down in past three months and remained at log 5.5. Do you think that I may have developed drug resistance to Adefovir? I am thinking that I start Entecvir to get the viral load to undetectable level and then switch to Adefovir to acheive eAntigen Seroconversion as the data suggests that Adefovir achieves sustained eAntigen seroconversion. Is this possible? My doctor does not have indepth understanding on this so I would like to get your valuable opinon. Do you know if Entecvir is going to be able to bring my viral load down? It seems that my ALT is 29 so there not much inflammation.

I had liver biopsy on 10/28/04 which showed Fibrosis stage 2 and inflammation grade 1. Here are my latest lab results.

October 31 2005,

HBV DNA = 310450 Copies/Ml or Log5.5

AST = 28, ALT = 29, eAntigen = positive, eAntibody = negative. Renal Function = Normal.

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 have completed 1 year of treatment and now I would like to know what treatment I should consider to achive undetectable HBV DNA load and eAntigen seroconversion. Can you please make any suggestion. In the past you mentioned that I could start Enetecvir after 1 year of Adefovir treatment so I am leaning towards that.

Thanks for your valuable help.

Response from Dr. McGovern

It appears that you have plateaued in your responses to adefovir, but I am not convinced you are resistant because your viral load has not rebounded and resistance development in the first year of adefovir treatment is unusual.

I think your HBV virus would disappear after a short time of entecavir treatment. As to whether you will convert your e antigen is less clear because your liver function tests are very low and both entecavir and adefovir have low rates of seroconversion. It is still worth trying and entecavir is very easy to take.

You have mild liver disease, so you have also "time on your side". More and more hepatitis B drugs are probably going to be available in the next few years as well.

Dr. M



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