Side effects of therapy

[Vireadeater]

Hi there,

I would like to discuss my Viread "side effects" with you. But first some relevant data.
Got diagnosed with Chronic Hep B in March 2011:

- Hbeag Negative
- Genotype D
- Grading 0-1
- Male

Started Viread (Tenofovir) in April:

- HBV DNA in April: 29.000
- HBV DNA in May: 45
- HBV DNA in August: Undetectable
- Hbsag in August: 30.000 (First time it got measured.)

So far so good, but here comes the "strange" data:

- ALT in April and before: Between 65 and 73
- ALT in  May after I started Viread: 93
- ALT in August: 93

Besides I have some "side effects" since I have been taking Viread that one could sum up as the typical symptoms of acute hepatitis b OR the side effects under Interferon:

- Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage). I never experienced that before taking Viread
- Flu like symptoms: Muscle aches; Headache, Temperature, Tiredness. They come and go. Again I did not experience that before.

My doctor says this COULD be some immune reaction but wants to wait for the next results in November. Because she was also a bit surprised by the rise of my ALT since she figured it should have rather dropped considering the decrease of my HBV DNA.

Any ideas out there? Anyone who experienced something like that in therapy? Would be glad to hear your thoughts and opinions. And thanks for this community here!

Keep it up!

[joc2011]

I also started on Viread in March 2011. Before taking Viread i had absolutely no symptoms. Upon resuming viread i started experiencing the same symptoms as you have. I checked out the viread site to see if these symptoms were normal and from what i read they seemed to be quite usual and covered in the broad range of possible symptoms experienced by patients while taking viread.
However i would like to hear any contrary opinions if anyone has any.

[Vireadeater]

Even though this might sound "naive" the "side effects" I mentioned do not "feel" like they were caused by the pills directly. If that makes any sense at all. It rather "feels" that there is something going on in my body hepatitis wise, which would explain the risen ALT.....Of course, they also do kind of fit into this very broad range of symtoms mentioned on viread.com. But it just does not feel like sides caused by some pills.

Did your ALT also change?

[enolia]

Check this info

Severe liver problems: Severe liver problems can happen in people who take VIREAD or similar medicines. In some cases these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis) when you take VIREAD. Call your healthcare provider right away if you have any of the following symptoms of liver problems: Your skin or the white part of your eyes turn yellow (jaundice), dark “tea-colored” urine, light-colored bowl movements, loss of appetite for several days or longer, nausea, stomach pain.

Just as a precaution, I believe you should get your liver checked with an ultrasound or any necessary test to ensure your liver is OK. It is not normal to feel pain. I personally didn't have any of these symptoms and my ALT went from 32 to 21. I hope it is an immune reaction that will cause your virus to be cleared but you can not just wait and risk the worst.

[Vireadeater]

Thanks Enolia. Might be the best to get an ultrasound...I will post the outcome...

[Izzy79]

Hi,

I started Viread therapy in August as a continuation of Entecavir therapy (a long story...). On 1. of August i just switched from Entecavir to Viread. One week later i woke up with a mild skin rush on my abdomen area, i had nausea after taking tenofovir( at the evening) an in the morning and i had also 4 days long fever about 39°C....and i´m PERMANENT tired:o(

Before starting Viread my ALT was 95 and two weeks later 113. I read somewhere that an elevated ALT count is normal after starting nucs (only the first few months), but I´m not sure, i hope that someone with more kowledges will read this to affirm it!

Now, more than a month after starting viread, i feel good( i have only nausea from time to time) and i pray for a negative PCR(the last one before taking Viread was 116).

I hope that the side effects that you experience will disappear soon!!!

[stef2011]

an alt rise with hbvdna undetactable is very very good, it means your immune system is killing infected cells and working in hbsag clearance, just recheck hbsag quantity if lowering you are clearing

alt rise may also be toxicity but very unlikly, if it is toxicity hbsag stay the same or rises.the alternative is entecavir which has no sides effects

Because she was also a bit surprised by the rise of my ALT since she figured it should have rather dropped considering the decrease of my HBV DNA.

how can she be so ignorant, hbvdna and alt has nothing to do if your immune system is starting to work you will have an alt flare between 200-300 to 1000 and will clear virus

- Flu like symptoms: Muscle aches; Headache, Temperature, Tiredness. They come and go. Again I did not experience that before.

this is interferon production....if you have no other infection this is hbv clearance....recheck hbsag quantity and hbsab quantity it will tell you if you are clearing

[stef2011]

people that clear hbsag on viread, very very few, have high hbsag like yours and hbeag positive at start of therapy

[Vireadeater]

@stef2011:
Nope, I do not have any other infection. In fact my high ALT was the only abnormal result of my last blood test. Everything else was fine. If I am clearing I would be more than happy. However, I do not want to put too much hope in it because from what I have read this would come close to winning the lottery. But then, someones gotta win it ;)
About my doctor, I do not want to put her into a bad light because she is really competent. She also mentioned that it could be a immune reaction and that she had some rare cases of people clearing it within a year. But I guess she did not want put any false hope in me at the moment. Even though she mentioned there is a chance of clearing considering the count of my hsbag. Anyway, she made it clear that we have to await the results in November...

@Izzy79: I only heard about the rise of ALT in therapy under Interferon so far. But maybe it also happens under nucs. Anyway, all the best for you and keep us informed. The negative PCR will come ;)

@all: Thanks for the discussion. It sure feels good to talk to people fighting the same fight!!!

[Vireadeater]

Since I am new to the topic is my count of hbsag high and therefore good? But I am not hbeag positive I am negative. Speaking of, what I still do not clearly understand because of all the misleading information in the internet. At the end of the day, is it good or bad if your body got rid of the hbeag?

[4est]

ALT in April and before: Between 65 and 73 - do you have 2 ALT measure in April ?
If yes the first one was 65 and the second one was 73 ?

If yes, maybe you should consider and discuss with your doctor that the ALT was "naturally" increasing and the increase is not to Viread.

[Vireadeater]

Both ALTcounts were before Viread:

65 in Febuary
73 in March
First Altcount under Viread in May: 93
Second Altcount under Viread in August: still 93

[stef2011]

At the end of the day, is it good or bad if your body got rid of the hbeag?

better positive because you can respond much better to drugs and also because on hbeag pos hbv usually hasn t escape your immune system by mutations yet...so many more chances to clear

hbsag quant monitor every 3-6 months can clear what is happening with infection and immune system so i'd refer mainly to this test...hbvdna and alt just complementary to hbsag quant

[4est]

so, in my opinion the ALT increase is not do to the Viread, actualy Viread stop the increase (or it was only a coincidence).
65 in May, 73 in March -> a increase without Viread in one month
73 in march -> 93 in may -> a increase but posible not to viread  (we have 2 mouth )
93 in may -> 93 in August -> same level under Viread (2 mounth), no increase, so we can say that viread some how stop the increase.

maybe is to mathematical, but also this option desired to be mentioned  

[stef2011]

after your other comments i have to agree your doctor is good, she is doing all correc tthings

[Vireadeater]

@all: Alright, thank you! Keep you informed...

[joc2011]

@ vireadeater:  
I only checked before i started taking viread. At that time my doctor said my liver was perfectly normal. Before i started taking Viread:HBsAG : Positive
Viral DNA=00/ Undetectable
Liver function: Very Good
Hep B Core Antibody: Positive
Anti HBe (igM): Negative
Anti HBe (igG)  (H): Positive. So my doctor suggested i take Viread for a year to make sure everything was under control.
Since resuming taking Viread in March and heavily dozing on fruits, taking vit B, C and D supplements i started having tired spells, which mostly happen early in the mornings and late evenings. At  those times i was also taking Chanca Piedra tea and was taking daily detox pills. So i decided to stop taking the teas and stopped the detox pills too leaving only the Viread and fruits.  Infact at a point getting out of bed in the morning became a problem, cos i'd be feeling absolutely wasted. I ran back to my doctor who said the symptons were normal and showed that the infection was clearing. He sounded so optimistic that we would achieve complete viral suppression by March 2012.
Months down the line up till this moment i feel great. I still feel a bit of sensitivity to the right side of my abdomen and occasional flu like symptons which come and go but all else is absolutely fine. Also i kind of feel my energy level was more before i started taking viread. But i am happy knowing that this is due to the fact that my immune system is fighting and clearing. I also plan to introduce Alinia soon.
@ all: Thanks all for all the encouragements and support. I love you all to bits!!!!

[4est]

"Viral DNA=00/ Undetectable" - I think that this was a mistake (I hope that no doctor prescribe Viread  if the viral load is undetectable )

[joc2011]

@ 4est:
Yes i got to find out the same thing. My Doctor was being overly too careful. He should never have prescribed Viread. Anyway, He said he will discontinue the viread for me in 6 months, but i also have to think of the best way to stop taking it safely. My Plan: Comboing Interferon with Alinia and then taking off the viread gradually.

[4est]

wow, indeed it was overly too careful or I don't know. I try to think on what he wanted to achieve, because all the doctors that prescribe nucs, they target viral load undetectable, but you already have this.
anyway, is to late to debate on this and as far as I read, your plan sound like a good plan to me, and I think that @Stef 2011 can advise you in more details.

bwt, do you check your AgHBs quantitative ?  

Good luck on your plan and if is posible keep us posted with the implementation and results.

[joc2011]

@ 4est:
Yes i got to find out the same thing. My Doctor was being overly too careful. He should never have prescribed Viread. Actually to be fair to him, When i told him after a month that i wasn't too comfortable taking viread as i was having a bit o f insomnia at the time, he was going to take it off, as he told me: "You dont need it. I only prescribed it just to be doubly sure we have everything under control". I then opted to continue it if it was going to have any benefits for me in any way. i was desperate at the time. Had just been told my HBsag was positive and i was pretty scared and desperate to do anything to assure my self i was going to be fine! Anyway, on my last visit,  He said he will discontinue the viread for me in 6 months from now, but i also have to think of the best way to stop taking it safely. My Plan: Comboing Interferon with Alinia and then taking off the viread gradually.

[joc2011]

@ 4est: Many Thanks. I actually have never checked my AgHBs quantitative. But i plan to do both AgHBs and AbHBs as soon as possible to track clearance. Will keep you all updated on implementation and results. Thanks again.

[Vireadeater]

@enolia: Got the ultrasound. Liver does not look abnormal. But for the bloodtest I will have to wait until November...

@all: One more question. Before I found out that I have chronic hepatitis in March 2011. I got vaccinated in 1998 (triple shot) and again in 2009 (one shot). So they say to be protected against HBV you need a titer >100. When the chronic Hep B got diagnosed I had a titer of 10. Finally the question: Does that mean that my immune system once reacted against HBV? Is that count valuable for anything: prognosis for therapy, date when I might have been infected (my doctor thinks before my first shots in 1998 but why do I have a bit of a titerthen?). Maybe someone here knows about this....thank you!

[stef2011]

hbsab to about 10miu/ml is not enough to clear hbv, you need it >1000miu/ml and hbsag to be low/undetctable

hbsab and hbsag detactable at the same time means hbsag has mutted and hbsb detected is useless

[Vireadeater]

Alright thanks!