Baraclude (entecavir) Resistance

[js1980]

Hi,

I amd HBsAg and HBeAg positive and HBV was detected sometime inmid 2006 (during routine tests related to pregnancy).  My doctor started treatment fromApril 2009with baraclude.  Before treatment here are the ALT and HBV DNA results.
SLT : 65 (ULN is 41)
HBV DNA: 9700000 copies /ML

HBV DNA and ALT has been monitoring every 3 months beyond April 2009 and with Baraclude, both ALT and HBV DNA viral load came down considerably.

In Oct 2009:
ALT: 42
ViralLoad :  in the range of 12 - 52  IU/ML.

In Jan 2010:
ALT: 38
Viral Load:  Less than 12 IU/ML

In April 2010:
ALT: 29
Viral Load: 22 IU/ML

In Jul 2010
ALT: 45 (41 is ULN)
Viral Load: 66 IU/ML

Note that between Jan 2010 and Jul 2010,Viralload increased from less than 12 IU/ML to 66 IU/ML.  Also, from April 2010 to July 2010,ALT increased from 29 to 45 .

Is it a case of resistance to baraclude? Are anyone in  baraclude therapy for more than a year and experienced anything similar,

Please help with your inputs.

Regards,
JS.

[stef2011]

hbvdna blips and flactuations lower than 50iu/ml are normal as long as hbvdna gets immediately down to undetactable but if there are no kidneys problems tenofovir is the most safe drug as regards resistance, it is the only hbv drug with no resistance at 4 years and no resistance even if hbvdna is not fully und

[vermaaman]

i am on baraclude for the last 2 years and i ahve seen it fluctuating.but over the last year it has been coming down.

[stef2011]

i wouldn t feel very safe but etv needs 3 muations for full resistance maybe he just add 1 or 2 mutations but then suppressed hbvdna again, other explanations are changes in immune response or low immune response for a period

[chanthou]

One of my friend experienced DNA fluctuation as well after one year Baraclude (more than 100,000 copies higher than the lowest point). But, 3 months later it became undetectable (less than 6 UI/ml on Cobas TaqMan). Now he has become undetectable for 9 months.  So, there are lots of strange things with Hep B.

[stef2011]

sorry made a mistake:
also note that hbvdna in the liver is much higher than hbvdna in the blood so you might have considerable hbvdna and replication in the liver. also hbe is still positive and this is another virologic failure

did you check your hbvdna mutations before starting treatment?LAM mutations are present even naturally and if you happen to have it etv is wrong

i had a secondary mutation (not resistance) from lam and adv naturally before starting treatment and since test detects these mutations when higer than 20% other mutations might be present but not detected....so this is way combo is very important anyway.i really don t understand the way doctors use their mind, they shouldn t prove combo is more effective but the opposite so we don t risk anything plus any other viral infection uses combos (hiv, hcv and so on even the stupid elyctobacter therapy)

[stef2011]

guideline has made treatment failure with entecavir and tenofovir monotherapy when hbvdna has not reached und by 1 year, your doctor has made a mistake and you might be exposed to etv resistance.also note that hbvdna in the liver is much higher than hbvdna in the liver so you might have considerable hbvdna and replication in the liver

i do suggest to combo with tenofovir and add nitazoxanide too to lower any resistance that might have developped and prevent future resistance

i am also on etv but started ntz combo from the 4th month since hbvdna still detectable and didn t combo with tenofovir because we will make staggered interferon when hbsag reaches 1000-1500iu/ml.

Ntz lowered my hbsag more than 50% in the first 4 weeks of combo so it also lowered my cccdna.you may also use it to lower hbsag but it will take at least 1 year before you see hbe negative and hbsag decrease

[choppedliver]

Actually, your 66 iu/ml is equivalent to 384.1 copies/ml, since you need to multiply by 5.82.  Isn't that right more knowledgeable people on this board?  So your comparision, I think, should be 12 x 5.81 = 69.8 copies/ml vs. 384.1, which seems to be more of a disparity that I initially thought.

What do people think?

[choppedliver]

Remember that you came down initially from 9.7mm, if I'm reading that correctly.  Please use a comma if you're using that many digits.  I don't think going from 12 to 66 is that significant.  More significant perhaps is your liver enzyme going from 29 to 45, but then you've been in the forties before.  

Again, I'm no doctor, but the movement of viral load by that degree is likely to be a sampling error or influenced by factors such as what you ate, time of the day, your condition on the blood draw day, etc.  I don't think it's significant, and judging by your initial load, Baraclude seems to be working.