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HBV treatment results
Aug 19, 2007

Dear Dr McGovern:

First of all, thank you for providing this service for those of us who are deeply affected by the disease...

I am an Asian American male age 32. I was diagnosed june of last year as Chronic HBV carrier (E Antigen positive). Initial lab: HBV Viral DNA > 2,5000,000,000 copies/ML. AST 79, ALT 207. Began treatment with Baraclude in July 2006 and DNA count began declining... 8/06 2,350,000 11/06 118,000 2/07 95,000 (AST26/ALT 32) however, in May 07 lab, DNA spiked up to 257,000 and my Dr. put me on a combination of Hepsera and Baraclude, last two labs show: 6/07 DNA 71,800 AST21/ALT25 8/07 DNA 23,000 AST19/ALT27.

my concern now is that even with the new drug (although only two month) I am still not at non-detectable viral load. What is your suggestion? wait and see a few more month? or going onto another class of drugs?

Thank You!!!

Response from Dr. McGovern

You ask an excellent question.

Baraclude is entecavir - a very potent drug for hepatitis B. You did achieve a remarkable decline in viremia (virus in blood) but your virus started to rebound up in May. This suggests the possibility of resistance developing.

Your physician opted to add Hepsera (adefovir) which does not have the same resistance patterns as entecavir. I agree with your physician's approach of adding and not substituting adefovir. As to the slow DNA response - that is typical of adefovir which is not as potent as entecavir. I would suggest that you continue taking both medications with excellent adherence and see what happens. You are close to viral suppression and I would continue with this plan for the next three months. I suspect you will suppress the virus soon. Alternatively, if you have access to tenofovir (a cousin of adefovir) you may want to use this drug instead. If not, continue with adefovir.

Best of luck.



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