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Baraclude 0.5mg resistance
Dec 30, 2009

Hello Dr.

A few months ago I asked a question regarding my Baraclude 0.5mg: My DNA levels were 3 billion. In March 2008, I was referred to a Liver specialist and had a biopsy and an ultrasound. Results were mild inflammation with no scarring present. I have been on Baraclude 0.5mg for 8 months now. In Apirl my levels decreased 4 logs: 180,000, June 28,000 and in October 24,000. Today November 12th, my Liver specialist was disappointed because he was expecting my levels to be undetectable.

Your response: I think your projected decline will certainly be a non-detectable viral load by 12 months for certain. Most data suggest that resistance is uncommon with Baraclude (entecavir) so I would stay the course. Best wishes for your complete virologic suppression!

As of December 24th 2009 my viral load has increased to 27,000. My liver specialist wants me to stop taking Baraclude 0.5mg because he said my body is not responding to the medication. He and his team are afraid I will be resistant to the medication.

My question now is: Should I continue taking the medication for another 3 months to see what the medication does in a year time frame? I have only been on the medication for 9 months.

I am extremely disappointed because I was told by my doctors and the forum that resistance is unlikely. Now, I have no medication to suppress my viral load. The prognosis now is to watch my viral load every three months. I am a 28 years old Vietnamese American. The doctors suspect I have had this condition since I was an infant or young child.

The only thing different that I have been doing is working out. My liver enzymes are elevated to 146 and 67. My CPK 10,000. The doctor told me to stop working out and drink Gatorade for about a week. He also said to get plenty of rest. My doctor also order lab work to check on my kidney functions. I suspect or at least I hope my abnormal lab results are due to my working out.

Please give me your honest medical opinion about my unique case.

Thank you in advance.

Response from Dr. McGovern

I am confused by your statement that you have no medications left to treat your hepatitis B. There are many medications that can be used to treat hepatitis B besides entecavir...

I would consider resistance testing to see what your drug resistance mutations are so the next course of therapy can be carefully planned. Depending on the results, combination therapy may be reasonable.

A lot of the decision making by the doctor who knows you best will depend on the extent of drug resistance (were you exposed to other medications in the past? This post does not indicate that you were) and the severity of liver disease (this post indicates mild disease) and your family history (? history of hepatocellular carcinoma).

I am also concerned by the high level of your CPK (muscle enzymes) and hope that you are getting prompt retesting of this level. I would not expect exercise alone would cause such a high level. Would also recommend testing of your kidney function and a urinanalysis. Would review carefully all your medications with your physician.



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