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To Stop or to Switch Antivirals
May 19, 2007

Adefovir gradually lowered my HBV DNA and improved my hepatic function panel. I would have stayed on the drug indefinitely but since my husband and I would like to get pregnant, I asked my gastroenterologist if I could stop taking Adefovir and monitor my numbers, and then get back to antivirals after delivery. Since my DNA count is in the undetectable range, I was quite confident on this option. But she wouldn't recommend to stop taking Adefovir but instead referred me to a hepatologist. The hepatologist recommended to take Telbivudine(Tyzeka) because it is a category B drug and has lesser risk in pregnancy. He suggested overlapping the two drugs for 1 week before fully switching to Telbivudine, and waiting for a month or two before conceiving. I am already 36 years old and this will be my first pregnancy. I hope you can give me your thoughts before I make any decision. These are my lab results:

before Adefovir (Hepsera) 03-2004: AST 54 ALT 58 Hep Be Ag: REACTIVE NGI HBV Endpoint Dilution: 430,000,000 Copies/ml

on Adefovir 06-2004 AST 80 ALT 109 NGI HBV Endpoint Dilution: 590,000,000 Copies/ml

on Adefovir 10-2004 AST 103 ALT 146 NGI HBV Superquant: 13,000,000 Copies/ml

on Adefovir 01-2005 AST 78 ALT 113 NGI HBV Superquant: 480,000 Copies/ml

on Adefovir 03-2005 AST 47 ALT 51 NGI HBV Superquant: 338,000 Copies/ml

on Adefovir 05-2005 AST 41 ALT 47 NGI HBV Superquant: 50,400 Copies/ml

on Adefovir 09-2005 AST 28 ALT 21 Hep Be Ab: Positive Abnormal Hep Be Ag: Negative NGI HBV Superquant: 1,400 Copies/ml

on Adefovir 12-2005 AST 24 ALT 22 Hep Be Surface Ab: <3.0 NGI HBV Superquant: 2,000 Copies/ml

on Adefovir 03-2006 AST 27 ALT 16 Hep Be Surface Ab: <3.0 NGI HBV Superquant: 200 Copies/ml

> on Adefovir 10-2006 AST 31 ALT 23 NGI HBV Superquant: <100 Copies/ml

on Adefovir 01-2007 AST 32 ALT 17 Hep Be Surface Ab: <3.0 Hep Be Ab: Positive Abnormal Hep Be Ag: Negative NGI HBV Superquant: <100 Copies/ml I have not had any biopsy. My ultrasound results are normal

Response from Dr. McGovern

I completely concur with the advice of your hepatologist.



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