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Chronic Hep B - Please Please Please Please Help
Jun 18, 2006

I have been taking Entecvir for the past 6 months. At 6 months my viral load has slightly increased to log4.7 from log4.3 that I did 3 months back. My ALT has improved currently my ALT is 22 which has decreased from 28 - 3months back. I am concerned about my viral load. It has slightly increased from log 4.3 to log 4.6. Is this something I should worry about eventhough my ALT has dropped from 28 to 22? I really really appreciate your valuable feedback. I would like to know if I should continue with Entecvir. Have I already developed resistance to Entecvir? before Entacvir I took Adefovir for 1 year and it dropped my viral load from log8.1 to log6.3 but after that it could not decrease the viral load.

Here are my latest results

HBVDNA = Log 4.7 base 10 (50,000 copies/ml) ALT = 22, AST = 21. eAntigen = Postive eAntibody = nehagative.

February 2006: My HBV DNA has dropped down to log4.3 or 20000 copies/ml. I have been taking Entecvire for the past 3 months. ALT = 28, AST = 27. afp = 2.8. EaNTIGEN = POSITIVE Eantibody = NEGATIVE 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 Thank you.

Response from Dr. McGovern

You ask an excellent question. However, with the data we have today there is no clear answer.

1. I agree with your concern that the entecavir is not having any impact. I would obtain resistance testing even though entecavir is not usually associated with resistance.

2. I reviewed your old data and it appears that you never had signficant elevations of liver function tests. Patients with this profile often don't respond to treatment as well as those who do. This is particularly true of interferon and lamivudine - medications you have not received.

3. Whether you would be better off on combination therapy has not been answered. Combination therapy is no more efficacious but it is associated with less resistance which is extremely important.

You may want to talk to your provider about trying pegylated interferon alfa 2a - a combination that can lead to seroconversion (E antigen negative to E antigen positive) more often than with other drugs. The other advantage is that you do not develop HBV resistance to peg IFN therapy so that is not a concern. It may be worth a try although your low liver function tests may me think it may not work. You will need to discuss side effects with your physician.



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