Deciding when to start treatment

Hi all, I’m Danny from Malaysia, I’m chronic HBV carrier. Just came back from specialist medical hospital to do my quarterly blood test, ultrasound on my liver. Utlsound found no finding or scare on my liver. HOWEVER, my blood test result shown my HBV Viral Load is 10100 (Unit - IU/ml). The Gastroenterologist Doctor advised me to take the Entecavir Sandoz Film-Coated Tablet. 0.5mg for duration of one month to reduce the HBV Viral Load. Is there any side effect for me to take the above drug as these is my first time taking it?.

Thank you



1 Like

Isn’t entecavir/tenofovir generally lifetime (unless you loose HBsAg, which is a very rare event etc., or VERY closely monitored for viral rebound)? Could any expert comment?

Yes that was told by doctor to take one month first to reduce the viral load. What I know that entecavir should be taken for long term not one month. Anyway I will meet up with specialist doctor at end of the month. Thank you very much for response to my question.

hi I’m not a health expert, but I think once you start entecavir/tenofovir you don’ t stop after 1 months taking it. speak with a liver specialist.
best Gregory

1 Like

Dear @Danny,

Welcome to the forum and thanks for sharing your experiences.

Re your question, the majority of people who take Entecavir experience no side-effects, though some do experience some (many for short periods only, and a small population have it continuously as they are on treatment). If this occurs, there are alternatives (e.g., tenofovir) or other formulations that can be taken instead. I myself am on tenofovir and have not experienced any side-effects due to it.

I also agree with the others, if you are put on treatment when you have a chronic infection, you should maintain treatment until the conditions for treatment cessation (e.g., HBsAg loss) are met. Doing otherwise could risk reactivation of viral replication and subsequent liver injury.

Hope this helps,


Thank you very much Thomas Tu for the information and I really appreciate it.

1 Like

Thank you for sharing. It means a lot.

1 Like

Hi Thomas and all experts,
I recently done MRE (MRI Elastrography) which I think may give more accurate Fibrosis score comparing to Fibroscan. Below are the fibrosis ranges

< 2.5kpa Normal
2.5 - 2.9 Kpa normal or inflammation
2.9 - 3.5 Kpa Stage 1-2 fibrosis
3.5 - 4.0 Kpa Stage 2-3 fibrosis
4.0 to 5.0 Kpa Stage 3-4 Fibrosis

5.0 Kpa Stage 4 fibrosis or cirrhosis

My liver Kpa calculated at 3.14 and 2.10. Report shows Stage 1-2 fibrosis noted within right posterior hepatic ROI.

My question is stage 1 - 2 fibrosis equivalent to F1 to F2 or F2 to F3 metavir fibrosis?
Also you have mentioned earlier antiviral therapy is recommended at significant >F2 Fibrosis. Is significant fibrosis starts at F2 or F3 ?

Hi @staystrong,

My understanding is that Stage 1-2 Fibrosis is equivalent to F1-F2. >F2 would equate to F3 and above.


thank you Thomas for your response.

1 Like

Hi Thomas,
I’m new to the forum. I’m considering starting treatment but concerned about potential side effects I read about. Good to know you are saying you don’t get any side effects, that’s the same pill I’ve been prescribed. How long have you been on it?

Hi @Winsome24,

I don’t remember exactly when I started but I think it must have been at least 10 years now.


Thanks for your response TT.

1 Like

Hi @ThomasTu, @availlant,

I am about to finally start taking the Entecavir treatment. I haven’t done it before since I wanted to see how the HB-Dna and HbsAg values vary without any medication.

The thing is that both of them were going down in the last 6 months, but recently they started going up again.

But I have a question: is it something common for HB-Dna to go from 3000 IU/mL to 4900 IU/mL and then 19500 IU/mL in just 4 weeks (I was tested 2 weeks ago at the public hospital and a few days ago in a private clinic)?

It seems a lot, even thought I know it can have fluctuations.


  • Mihai

Hi @Mihai_P,

Good question. I don’t know if many studies have been done on this as not many people get 3 HBV DNA tests within 4 weeks. We don’t know how much the HBV DNA varies from day to day or week to week.


1 Like

Hi @ThomasTu,

Thank you for your answer. I will start taking Entecavir today, but after reading the information leaflet of multiple medicine brands, I noticed one thing:

All of them mention that there is a slight chance of “hepatitis exacerbation”, mainly increase of ALTs between the 4-6 weeks. I wasn’t aware about this kind of side effect and the medic I’m going to didn’t tell me about it.

So my question is: after starting taking the medication, how often should I repeat the blood tests in order to stay safe? Every month, every three months, or every six months?

I’m concerned about my ALT levels going up as a side effect to Entecavir, without me knowing about it, and ending up having the liver damaged.

Thank you!
– Mihai

Great to hear, @Mihai_P. Just to frame the context, the decision to put you on treatment has likely been made to minimise the damage to your liver and any impact by the drug on hepatitis is far outweighed by the prevention of ongoing liver damage by the virus.

Regarding the hepatitis exacerbation, my understanding is that this is generally a sub-clinical phenomenon - no symptoms, just raising of the ALT numbers. I am not sure we know why this happens and whether liver damage is actually even associated with it.

The level of monitoring will depend on many of your other values, so the frequency of blood tests will need to be set by your doctor for your specific needs.

Hope this helps,

1 Like

@NeptuneJ @Albasil808 I wanted to find out if you started treatment and if yes why? By now you should be 48? Was reading your 2020 post with interest. How are things? Am CNN 44 yrs and not yet on treatment…the.musical chairs thing… I am hoping this stays and that it doesn’t cost me in the long run. My viral load never been past 300…

Hi Mihai . I am pediatrician and PLHBV .I was first detected with HBV during screening in medical school at 6th year medical student around 1990 and asymptomatic. In 1992 during 2nd year pediatric resident training , I turned to phase 2 /immune active phase and consulted my GI medical teacher,at that time , chronic HB was classified as CAH , CPH&CLH by liver biopsy . I suffered for CHB for 2-3 years during my clinical pediatric training with liver enzymes fluctuation(but mild symptoms just anorexia)between normal to 10xUNL
and liver biopsy showed chronic persistent hepatitis. I reject IFN @2b which was the only antiviral at that time due to its side effects.I strongly attention to use my immune to control virus by exercise. Then HBeAg seroconversion to HBeAg -ve within 2 year (1994) and ALT turned to normal (HBV DNA wasn’t available at that time).In my experience, CHB patients with flares/hepatitis exacerbation mostly mild symptoms even moderate to high elevation of ALT (5-10x UNL) . As you are worried about the side effects of ETV , especially the ALT flares after start treatment within 4-8weeks , it is a host-induced flares (good flare )when virus was suppressed then HBV DNA level decline and follow by ALT level increased due to body immune T lymphocytes response(necroinflammatory process )especially in HBeAg +ve / high viral load and different from viral- induced flares (bad flares)due to drug resistance which HBV DNA level increase follow by ALT elevation . Fortunately, ALT flares in a small number of patients (6.3%) (Chi H et al J Gastroenterol Hepatol 2016 ). In medical practice, we don’t frequently follow up ALT and HBV DNA , about 3-6 months after start treatment , so we don’t detect these flares due to sub clinical symptoms and signs. When I started treatment with TAF 4years ago (2021) when I monitored HBV profile and turned from immune control inactive carrier (phase3) to immune reactivation (escape )phase 4 . I didn’t had any side effects and everything go well . I hope that my information may help you in decision making for your treatment , so don’t worry, everything is OK , do the best .

Best regards


Thanks for this post. Can someone remain in phase 3 and what’s the probability? Also, of moving to phase 4 (from partial cure to reactivation or immune escape)associated with anything i.e what’s the average age for those infected at birth? Maybe @availlant can also chime in. Does age play here?