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Epivir or Adefovir
Mar 23, 2007

Hello Dr. thank you for answering my question. I am in a unique situation that my GI doc is asking me to seek a second opinion. When I first started tx for Hep B, my HMO placed me on Epivir and after taking it for 3 months, my viral load dropped to 685000 copies/mL with 16 AST and 21 ALT. Then I switched to a PPO doc and he decided to switch me to Adefovir. Now after being on Adefovir for >9 months, my viral load has shot up to 5730000 copies/mL. My AST is is 16 and ALT is 22. Do you recommend staying the course with adefovir or switching back to Epivir?

Response from Dr. McGovern

Difficult question. I would be somewhat concerned about adefovir resistance. Since you were only on epivir for 3 months, you probably did not yet develop resistance to that drug, especially with a good result. I would consider entecavir at this point, which is a more potent drug. If you have E antigen positive infection, another consideration is 48 weeks of Pegylated interferon alfa 2a for 48 weeks.



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