StephenCastlecrag / Stef2001 / anyone....
Please help me with your input understand if what I'm thinking is dangerous, so little data and studies I could find. Gilead must've tested various doses of TDF during trials before releasing it but no data published and available from them on effect of different dosing..
Planning on reducing current daily dose of TDF 300mg to 150mg daily or to 300mg every other day in an attempt to lower the possible damage kidneys and to slow down damage to bones (osteoporosis started), and perhaps less chance for lactic acidosis.
Background:
Was on Lam for 13 years (last 3 years of which in combination with Adefovir), both were stopped followed by near death acute flare up and TDF was started. On TDF mono therapy since then and continuing.
Already 15 years of TDF 300mg every day.
Previous Nucs caused mutations (as of 2008): N236T, A181V, M204I, M204V and L180M.
I am 68, HBsAg-pos HBsAb-neg, ALT-good(22), DNA-undetectable, HBsAg- pos,quantity N/A, Fibroscan-7.4Kpa, Vit.D3- 5000IU daily and 10000 daily in Winter (50ng in blood), HBV genotype-N/A.
Would like to ask:
1. Am I right to consider TDF dose reduction to 150mg a day?
2. Could "weaker" dose have less impact on the virus and allow it to "gain strength" in replication or something else?
3. Could it also make it easier for the virus to produce mutations?
4. Could it help the existing mutations from previous Nucs exposure "wake up" and escape the suppression TDF had on them while on full (300mg) dose.
Will be most grateful for your opinions,
Regards and be blessed, Peter
I may suggest that you consider stopping your HBV medication. This may lead to HbsAg negative, or HBV inactive(hbvdna < 2,000 IU/ml, ALT normal, no medication), or a rebound in hbvdna and need to resume TDF. This should be done only under the close supervision of an experienced liver specialist. A quantitative assay for your serum HBsAg may guide your decision.
According to your reply to Melcul, I don't see why you should worry about your kidneys right now. If you do want to change, consider Entecavir( I don't think your previous experience with Lamvidine should matter as your hbvdna is undetectable, but does require closer monitoring for possible Entecavir drug resistance), or TAF.
Just my opinions, all the best.