HepB ;treatment with Pegasys
Apr 3, 2011
Dear Doctor, thank you for the prompt answer. Are you suggesting that although I have now undetactable viral load (after 1 year in Pegasys) to start now therapy with oral agent or shall I wait when my viral load will be detectable again ?? Also we have not heard anything in the last 1-2 years for new medicines for HEPB - is there any progress on that front ?
Response from Dr. McGovern
I can't remember your initial post well. If I remember correctly, you were HBeAg negative and I was worried about relapse.
You could certainly see if the virus rebounds with treatment discontinuation; but I suspect the risk is high. If you do this, you should have frequent monitoring of your liver function tests, which will probably become abnormal as soon as the virus rebounds. Then I would start oral therapy as soon as possible since it will be easier to reduce you to a non-detectable viral load. Sometimes rebound of viremia can be associated with a significant flare of liver tests so I would like you to monitor this closely.
After several years of new agents, we are slowing down right now. However, the exciting thing is that tenofovir and entecavir resistance profiles look better than most. In your case, the choice of agent should be a safe one, since your main issue is keeping viral suppression - resistance is less of an issue when you are already suppressed. Safety is more of the issue when you are on a drug for a long time. Most of the HBV agents have a good safety profile although ongoing laboratory monitoring is very important.
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