Aa
Combating Resistance
Guys,
Recently i saw a couple of posts regarding certain tx where resistance occurred. Firstly, when we say resistance are we assuming that where the tx initially brought down DnA, virus status, ALT etc.... these have suddenly shot up again whilst still on meds? If so, does that mean my treatment of Adevoir + Lumuvudine was gradually getting overpowered. The reason behind my thinking is, I was put on combo treatment for at least the year. My DnA levels continued to go down from the thouands to UND (in the 11th month). My ALT was consistently sitting between 21-17ish..... However, on my last month of treatment (12th month) and literally a few days before i stopped i found out my DnA had gone from UND to something like 53IU/ML. Could this mean in the 12th month i was in fact building up a resistance to the tablets?
Since coming off treatment i have noticed that my liver feels more sensitive and swollen... Is this normal or should i be on the phone to my hepitologist before my next appointment on the 25th of Aug...
Finally if for some reason i do have to go back onto treatment (for life) would i assume it would be adevior+Lum again or woud it be another form of combo treatment? If so, please advise what other proven combinations are out there? I would assume it would have to be combo simply because of the quickness of resistance build-up on mono-tx.
Are there not certain tablets that create resistance right away...?
Soz for the numerous questions but when i'm typing away my mind has so many different questions...
P.s Hope all is well.... Good to see so many newcomers... Theres millions of us!!! Lol
Recently i saw a couple of posts regarding certain tx where resistance occurred. Firstly, when we say resistance are we assuming that where the tx initially brought down DnA, virus status, ALT etc.... these have suddenly shot up again whilst still on meds? If so, does that mean my treatment of Adevoir + Lumuvudine was gradually getting overpowered. The reason behind my thinking is, I was put on combo treatment for at least the year. My DnA levels continued to go down from the thouands to UND (in the 11th month). My ALT was consistently sitting between 21-17ish..... However, on my last month of treatment (12th month) and literally a few days before i stopped i found out my DnA had gone from UND to something like 53IU/ML. Could this mean in the 12th month i was in fact building up a resistance to the tablets?
Since coming off treatment i have noticed that my liver feels more sensitive and swollen... Is this normal or should i be on the phone to my hepitologist before my next appointment on the 25th of Aug...
Finally if for some reason i do have to go back onto treatment (for life) would i assume it would be adevior+Lum again or woud it be another form of combo treatment? If so, please advise what other proven combinations are out there? I would assume it would have to be combo simply because of the quickness of resistance build-up on mono-tx.
Are there not certain tablets that create resistance right away...?
Soz for the numerous questions but when i'm typing away my mind has so many different questions...
P.s Hope all is well.... Good to see so many newcomers... Theres millions of us!!! Lol
Thanks for your replies...
Sharp7 - I'll definately have a look at that link you sent... What i meant by resistance for tablets is. Are there tabs out there that the virus will instantly resist from the get go... So from the first couple intakes. Also when it comes to flare ups i wasn't so concerned with my ALT which hasn't really seen much fluctuation. I'm more worried bout the fact i was UND then went to 53IU/ML on my last month... I was wondering if this was an indicator the virus was building resistance.
bberry - I came off meds about 3 weeks ago now.
'53 unitsrent the greatest number i would worry about but maybe if i were you i would closely' - not quite sure what you meant here...Did you mean as 53 isn't a massive number so not too much to read into here?
The one thing i can't understand is, my hepitologist wasn't too concerned bout an instand schedule after my last day of treatment... As mentioned i finished my last day of tx 3 weeks ago and my next appointment isn't til 25th of Aug. Was this gap too long for check-ups?
Yes i seroconverted a little while back... As the immune system is more adapt to combating the virus could there be a possibility i will go back down to UND without the help of meds?
Lastly 1 tab instead of 2? I guess i can see the point of that... Although if i was to go back on tx it would most probably be for life... Would combo not be better as resistance normally takes longer?
Sharp7 - I'll definately have a look at that link you sent... What i meant by resistance for tablets is. Are there tabs out there that the virus will instantly resist from the get go... So from the first couple intakes. Also when it comes to flare ups i wasn't so concerned with my ALT which hasn't really seen much fluctuation. I'm more worried bout the fact i was UND then went to 53IU/ML on my last month... I was wondering if this was an indicator the virus was building resistance.
bberry - I came off meds about 3 weeks ago now.
'53 unitsrent the greatest number i would worry about but maybe if i were you i would closely' - not quite sure what you meant here...Did you mean as 53 isn't a massive number so not too much to read into here?
The one thing i can't understand is, my hepitologist wasn't too concerned bout an instand schedule after my last day of treatment... As mentioned i finished my last day of tx 3 weeks ago and my next appointment isn't til 25th of Aug. Was this gap too long for check-ups?
Yes i seroconverted a little while back... As the immune system is more adapt to combating the virus could there be a possibility i will go back down to UND without the help of meds?
Lastly 1 tab instead of 2? I guess i can see the point of that... Although if i was to go back on tx it would most probably be for life... Would combo not be better as resistance normally takes longer?
pete, how long has it been since you came off the meds? 53 unitsrent the greatest number i would worry about but maybe if i were you i would closely - VERY closely monitor maybe once every two weeks or once a month for some time to see if it a normal flutuation or if it is an upward move that might cause a problem.
it depends on when you've stopped treatment
as for the swelling and discomfort, i would check with the doctor but i would imagine that there would be some type of discomfort specially that you're off the meds and your liver is literally on its own now.
as for other meds and resistance, ,not sure you "would" go back on combo.. remember ur immune system has already identified the virus and formed some control over it hence seroconversion from hbeag pos to neg with pos hbeab
if, God forbid, u needed to go back on meds, i'd imagine they would try one pill on you instead of two.
let us know how ur meeting goes with your doctor
good luck
it depends on when you've stopped treatment
as for the swelling and discomfort, i would check with the doctor but i would imagine that there would be some type of discomfort specially that you're off the meds and your liver is literally on its own now.
as for other meds and resistance, ,not sure you "would" go back on combo.. remember ur immune system has already identified the virus and formed some control over it hence seroconversion from hbeag pos to neg with pos hbeab
if, God forbid, u needed to go back on meds, i'd imagine they would try one pill on you instead of two.
let us know how ur meeting goes with your doctor
good luck
Most of the issues you brought up are covered in http://www.hepatologytextbook.com/.
One thing I want to correct, though: "Could this mean in the 12th month i was in fact building up a resistance to the tablets?" Unlike drugs like painkillers where *people* develop resistance, with anti-virals and antibiotics, it is the *virus* that develops resistance.
If you feel any pain, you should definitely talk to your doc right away. However, if we rule out psychosomatic pain, I think it is unlikely that your HepB virus is causing it. This is my understanding: the virus by itself, is fairly harmless. If your body's immune system detects that some cells are infected, it starts destroying the cells. That is what causes the ALT flare. Again, this is my belief, don't take my word for it: if a chronic hepper has a VL of 53 IU/ml for a few days, it is not large enough to trigger an immune reaction. I see no reason your ALT would shoot up with such a low viral load. With acute infections though, this VL may be enough to trigger an immune reaction -- I don't know for sure about the numbers.
Recommended combinations to counter resistance: see page 147 of the textbook I have given the link for. Page 146 talks about how they came up with these recommendations.
"Are there not certain tablets that create resistance right away?" Not sure I understand your question: as you can see from page 146, all these tablets are susceptible. The virus can develop a resistance to any of them! Some more readily than others. So far we have not seen the virus develop resistance a couple of tablets... I guess that is only because these tablets have not been around for a couple of years.
One thing I want to correct, though: "Could this mean in the 12th month i was in fact building up a resistance to the tablets?" Unlike drugs like painkillers where *people* develop resistance, with anti-virals and antibiotics, it is the *virus* that develops resistance.
If you feel any pain, you should definitely talk to your doc right away. However, if we rule out psychosomatic pain, I think it is unlikely that your HepB virus is causing it. This is my understanding: the virus by itself, is fairly harmless. If your body's immune system detects that some cells are infected, it starts destroying the cells. That is what causes the ALT flare. Again, this is my belief, don't take my word for it: if a chronic hepper has a VL of 53 IU/ml for a few days, it is not large enough to trigger an immune reaction. I see no reason your ALT would shoot up with such a low viral load. With acute infections though, this VL may be enough to trigger an immune reaction -- I don't know for sure about the numbers.
Recommended combinations to counter resistance: see page 147 of the textbook I have given the link for. Page 146 talks about how they came up with these recommendations.
"Are there not certain tablets that create resistance right away?" Not sure I understand your question: as you can see from page 146, all these tablets are susceptible. The virus can develop a resistance to any of them! Some more readily than others. So far we have not seen the virus develop resistance a couple of tablets... I guess that is only because these tablets have not been around for a couple of years.
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