Confused between ETV/TFA for initiating treatment

Just diagnosed or new to the community
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Hi… firstly thanks for creating this community. Since we can’t have real world fellow HepB patient communication due to privacy.

I’m 29M, height - 177cm, weight - 66kg, from Nepal. Diagnosed with HepB in last year while I went for blood donation for a cancer patient. Later realized my father died from liver cirrhosis (and not Jaundice) so I’ve a family history (checked his death certificate). Haven’t started treatment yet.

June 2023-
viral load - log 9. ALT AST normal but just below max permitted.

As on June 2024-
Viral load - log 8.98. value - 956000000
HBeAG - reactive value - 1016.51
Prothrombin Time (PT) - 10.4

ALT (SGPT) -
Oct 2023- 49, April 2024- 56, June 2024- 83, September - 155 , Nov- 170, Dec - 171

AST (SGOT) -
Oct 2023- 32, April 2024- 34, June 2024- 51, September - 77, Nov-95, Dec - 89

Fibroscan Dec 2024 - normal.
CAP (dB/m) - 191. SD - 5
E(kPa) - 6.7
IQR - 0.2
IQR/Med - 2%

Rest all November 2024 values -
Lymphocytes - 42
Absolute Basophil count - 0
Platelet Distribution width (PDW) - 17.2

Kidney Health -
Urea - 17.12 (below normal)
Blood Urea Nitrogen- 8 (below normal)

Cholesterol -
Non HDL- 134
HDL - 120
Total - 189

Bone Health - calcium - 8.67 (just below min)

Diabetes - Glycosylated Hemoglobin (HbA1c)- 5.9

Vitamin D - 21.15

Doctors prescription -

Oct 2023- One Doctor prescribed no treatment and LFTs every 3 months. Other asked to initiate. I chose not to initiate.

June 2024- one doctor prescribed ETV (50mg) . Another doctor asked to not worry, continue healthy living.

I left sugar, followed diet restrictions. My weight reduced from 76kg in April 2024 to 66 kg in November 2024. I thought, I was going on right path but unfortunately Nov 2024 tests showed that ALT ASTs are on rise.

Nov 2024 - Another doctor prescribed Tenocruz AF (25mg) after breakfast.

Due to rising ALT, AST, family history and high viral load; after reading latest WHO guidelines
and this community post; I think there is no option. I’ve not taken medicine entire life for illness and generally leave it to immune system, good diet. But here these things are not working. I’m not able to start as I’ve read about side effects although without medication, currently my body seems fine physically.

My questions are:

  1. between ETV and TAF, which is the better since I may need to take for lifetime ? Can I take generic of TAF rather than Tenocruz? Any difference in effectiveness?

  2. can I wait for sometime to reduce it via extensive exercise in gym, like I did for last month (nov- dec) which stopped rising enzyme levels ?

I want to take decision before new year. Pls help. Thanks

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Hi @Soldier,
Welcome to the community and thanks for your question. I am unsure why you have chosen to delay treatment given the fact that your father died from HBV complications? With your very high viral load and rising ALT and AST, If I were in your shoes I would start treatment now. While physical exercise is good for the body, it does not play any role in your HBV situation. Many of us exercise, eat healthy, and still take antivirals. ETV and TAF are both great at slowing the progression of the disease. TAF is more expensive and might not be readily available in generic form since it is still under patent. ETV has been around for some time so there are generics available. Both work well.

Based on your results and family history my advice is to start treatment as soon as possible so you don’t do any serious damage to your liver and reduce your viral load. It is all up to you, as they say the ball is in your court. HBV is not a virus you want to play with or not take seriously.

Read this article here to understand what can happen when people joke with their HBV diagnosis. Best, Bansah1

A Cancer-Causing Virus Hiding in Millions of Americans. By Ingfei Chen (New Yorker)

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Hi @Soldier,
Oh, I forgot. Taking antivirals for life is not as scary as you make it sound. Once you start, it is so easy as many of us have found out. You are not the only patient hesitant to start treatment because of the possibility of it being lifelong, we have all been there. Think about it, there are two options:" take a pill each day for the rest of your life and live" or “do nothing and die from HBV complications”. This is not to scare you, but it is the truth we all face. I have seen what this virus can do to people so I don’t mess around with it at all. Best, Bansah1

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Thank you so much @Bansah1 for sharing your advice promptly. I’m also reading article suggested. I will start treatment from tomorrow morning. No more delay

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Welcome to the forum and thanks for your questions, @Soldier.

Regarding the first, all the first line therapies (ETV, TDF and TAF) all work similarly well in suppressing virus replication. Tenocruz appears to be the generic of TAF.

Regarding the second question, exercise and diet (while both are important in maintaining general health and wellbeing) are not effective ways to reduce ALT levels or viral load.

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Thanks @ThomasTu , heartily appreciate prompt response and clarifications. Will update my treatment progress here.

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Just to echo what is said before, entecavir and tenofovir are both excellent anti-viral strategies and with your history I would recommend whatever is available to you. The nuances of therapy depends more on your combidities (none of which appear to be a problem for you) and renal function (again fine). Good on you for sharing your concerns and taking charge of your health!

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Hi All… just would like to thank @Bansah1 @ThomasTu and @AnnaDi for sharing your opinion. @Bansah1 the story you shared and lot of other stories on HepB community who delayed treatment and developed cirrhosis helped me push for making decision. Somehow apart from doctors, reading real life stories of affected people impacted me more.

Just would like to tell that today early morning, I took bath, went to nearby holy place for taking blessings and then started my treatment with TFA. Took it along with my breakfast.

Happy to have taken the right decision. Thanks

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Hi @Soldier,
Don’t mention it. That is what we are here for. I am glad you had all the information needed to make such a decision. You should be proud of yourself for making this decision despite it feeling scary. Give it a few weeks and you will notice how easy it is to take these antivirals. Best and keep us posted on how things are going from time to time. Bansah1

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Hi fellow fighters… it’s been 8 days since I started treatment… I’ve not noticed any side effects till now… Thanks

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Starting my journey with Vemlidy as well. Proactive steps better than reactive steps. Hope all goes well. Stay safe brother

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Best wishes Ash… I’m really at much peace in comparison to everyday worry few days back… additionally I’m continuing with my exercise and relatively healthy diet

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is you hbsag level mentioned above quantitive or just qualititive ? Is there unit like IU or copies per/ml ?
It’s important because you are HBeAg+ so higher change for functional cure on interferon but more important is HBsAg start level (and genotype if you know it)

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HBeAG unit is A/CO. I had done HBV DNA quantitative test. My DNA Viral Load is 8.98 log value i.e. 10^9. Precisely it is 956,000,000.

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Am yet at 1660iu/ml with normal ALT. Waiting for the advice to start treatment or not