TDF vs TAF vs ETC for treatment naive patient

[hopeforhbvcure]

Hello All,

I am a chronic HBV patient (diagnosed in 2011) of 35 years old, married and my wife is boosted with antibodies.

I think I became eligible for treatment because of my recent ALT spike and viral load spike.

1) ALT
Dec 2013 - 86 U/L
Nov 2014 - 112 U/L
July 2015 - 75 U/L
May 2016 - 51 U/L
Nov 2016 - 58 U/L
Oct 2018 - 27 U/L
Feb 2020 - 30 U/L
Feb 2021 - 35 U/L
Oct 2021 - 29 U/L
Sep 2022 - 81 U/L

2) AST
Dec 2013 - 48 U/L
Nov 2014 - 60 U/L
July 2015 - 78 U/L
May 2016 - 34 U/L
Nov 2016 - 43 U/L
Oct 2018 - 24 U/L
Feb 2020 - 27 U/L
Feb 2021 - 30 U/L
Oct 2021 - 65 U/L
Sep 2022 - 46 U/L

3) HBV DNA
Dec 2013 - 773016 IU/ML
Nov 2014 - 1192560 IU/ML
July 2015 - 321542 IU/ML
May 2016 - 537 IU/ML
Nov 2016 - 3560 IU/ML
April 2017 - 2276 IU/ML
Oct 2018 - 1324 IU/ML
Feb 2020 - 292 IU/ML
Feb 2021 - 3312 IU/ML
Oct 2021 - 18141 IU/ML
Sep 2022 - 850689 IU/ML

4) AFP
Dec 2013 - 5.2 ng/ML
Oct 2021 - 4.5 ng/ML
Sep 2022 - 4.4 ng/ML

5) Thanks to the group (special mention to stef for being such a strong advocate) as I am consistently taking fibraoscan and ultrasound since 2013.

The latest fibroscan in Sept 2022 says 4.4 kpa while the median stiffness number in the ulstrasound shows 7.8, not sure which is more correct. However, the ultrasound shows fatty liver and mild fibrosis, planning to reduce my BM from 28 to healthy levels.

6) Thanks to the group for being strong advocate of Vit D intake, as I have been taking high doses of vit D but stopped taking since 2018 as my scrotum ultrasound shows calcium deposits.

However, my Vit D is on the lower side consistently since 2018 around 20 ng/ml, need help from the group about how i can increase the intake without messing up calcium levels

8) Cure on HBV
Like most of the folks, I am also hopeful about the cure in the next decade about replicor and bepirovirsen. I am considering a small investment in Replicor to do the little contributrion from my side for the drug to hit the market. I told Andrew, how our medhelp community has pinned hopes on a drug like Replicor.

9) Waiting on quant hbsag numbers still

Questions:

1) Which drug do you recommend between TDF VS TAF vs ETC. I have heard about a lot about bone mineral density and kidney issues with TDF and ETC to some extent. Do we have consensus in the community that TAF is a better NUC ? What else can i do minimize the side effects like vit D intake etc.. ?

2) Does any of the NUC have any effect on male fertility as I am planning to have kids in near future ?

3) I have been hbeag negative since 2013, but I am not sure why the viral load which was decreased has started increasing from the last year, I took covid vaccines and not sure if the vaccines flare the viral load. Is that spike expected after the decline from 2015 to 2018 ?

4) I am aware that hbv has the following paths for hbeag negative patients
a) Fibrosis  -> Cirrihosis -> Hcc
b) Direct hcc

I believe the NUCs and constant monitoring via US/Fibroscan will help us manage the path (a), however for (b) what else we could do ? Does Nucs help minimize (b) ? I am drinking coffee every day and wondering what else we could do here?

5) Question related to Vit D as stated before with respect to calcium intake? What is the best way to take Vit D and other vitamins

6) Question related to fibroscan, which stifness numbers are accurate for hbv, the one from echsosense fibroscan machine vs the sitffness numbers reported from ultrasound ?

[StephenCastlecrag]

I am not a doctor, I will try to answer some of your question. I don't know your status (HBeAg, hbvdna, and ALT) when you were diagnosed in 2011. However, it seems you were in the Immune Control Phase(aka inactive phase or HBeAg negative liver disease) when hbvdna < 2,000 iu/ml and AL is normal( Cirrihosis -> Hcc
b) Direct hcc

I believe the NUCs and constant monitoring via US/Fibroscan will help us manage the path (a), however for (b) what else we could do ? Does Nucs help minimize (b) ? I am drinking coffee every day and wondering what else we could do here?

I am not sure US will measure your liver stiffness. Fibroscan is considered a form of US. Fibroscan can also measure CAP score to grade your fatty liver. For (b), the only thing at the moment is early detection, that is, an US and AFP every six months. Early HCC is curable. Coffee should reduce fibrosis.

5) Question related to Vit D as stated before with respect to calcium intake? What is the best way to take Vit D and other vitamins

Stef is the best person to ask. I only know you should maintain a adequate level of Vitamin D through regular exposure to sunlight and a good diet.

6) Question related to fibroscan, which stifness numbers are accurate for hbv, the one from echsosense fibroscan machine vs the sitffness numbers reported from ultrasound ?

As I say previously, I don't know ordinary US will measure liver stiffness. Liver stiffness should be measured when ALT is normal. 4.4Kpa is almost no fibrosis. 7.2 Kpa is considered F1. Check with your doctors and radiologists.

Replicor is now privately held and will not accept investors. We all wish REP2139 will proceed to a Phase III clinical trial.s and get FDA approved. Bepirovirsen  is hopeful. The latest news is that long time use of NUC may silence cccDNA, but there is still serum HBsAg from integrated hbvdna. So a new definition of functional HBV cure may be needed.

Just my opinions and all the best.

[hopeforhbvcure]

Thank you so much for the response.

b) Direct hcc

I believe the NUCs and constant monitoring via US/Fibroscan will help us manage the path (a), however for (b) what else we could do ? Does Nucs help minimize (b) ? I am drinking coffee every day and wondering what else we could do here?

For (b), the only thing at the moment is early detection, that is, an US and AFP every six months. Early HCC is curable. Coffee should reduce fibrosis.

- Does NUC doesn't help prevent or minimize the chance of direct hcc scenario ? The NUCs should reduce the viral load right ? what else would contribute to the the direct HCC path. If someone is already on NUCs and got HCC, what other medications are available to cure the early hcc ?

[StephenCastlecrag]

Direct HCC can affect many people, even those without HBV. As with all cancers, early detection can be cured. There are a number of medications for people with HCC, regardless of etiology, consult a liver cancel specialist. Usually, a liver transplant can provide a cure for HCC.