Drug resistance?

Hello everyone - I am new to the board and also to new to HBV treatment. I’ve been infected since I was 8 according to my mother but I suspect I was probably infected since birth and I’m happy to meet everyone and am looking forward to support everyone anyway I can.

I am 38, recently I had my ALT levels at 200 and HBV DNA for the first time in the millions. My specialist put me on Vemlidy and I’ve been on it daily for a month and a half now…very little side effects…I had another ALT test ordered by my doctor a little less than a month after my treatment began…the ALT was still elevated but down to 98 from 200 My fibroscan was at 4.8.

just wondering…what are the odds of drug resistance being developed? according to my doctor I’ll be on this drug for the rest of my life…and also…I am an occasional marijuana smoker…would that be ill-advised? no alcohol ever.

Thanks again.

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Hi @joseph,

Welcome to the community, and good to hear that your ALTs are down after starting treatment. Also thanks for asking the great questions!

  1. Drug resistance to tenofovir is extremely rare. From my conversations with our hepatologists, they almost never see it. We also have 2 drugs available, so if tenofovir doesn’t work people are generally transferred to Entecavir instead. Resistance to both drugs has not been reported before as far as I can tell.

  2. Regarding marijuana, I don’t think there are any strong studies that show safety either way: it’s mentioned briefly on the hep b foundation website here - Ten Things You Should Know About Hepatitis B and Do in 2017 - Hepatitis B Foundation.

Hope this helps.


Hi Joseph,

I’m a senior HBV virologist with an active drug discovery project vs HBV. Thomas is absolutely right about there being almost no drug resistance to Tenofovir. I’ve been paying attention to this in the literature and have seen only a few convincing cases of real drug resistance vs. tenofovir in years of searching. From a virologist’s point of view, this is amazing because the same drug is used widely vs. HIV, and unfortunately HIV can develop resistance to it at a more normal rate. For unknown but delightful reason(s), HBV has some incompatibility with the possible resistance mutations. Thomas is also right about there being a great backup drug (generic name = Entecavir, brand name = Baraclude). It works the same way as Tenofovir and also has an exceptionally low resistance profile

Staying away from alcohol is always a good idea when you have a liver disease. I don’t know the specifics of how they may interact, but adding another stress on the liver just seems to be something to avoid.

I’ve never seen anything in the literature about marijuana, and the quick search I just did on PubMed revealed no information on how harmful it may be. That does not mean it is necessarily safe (or harmful either), but just that there is no data available on the risk.

I’m delighted tenofovir is working so well for you!

John Tavis

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Thank you for your answers it does make me feel better.

The thing about my specialist is that he definitely knows what he’s doing…but he’s also not the type that explains stuff to make you feel better…you’re supposed to do what he tells you and that’s it lol so this is really reassuring.

I was paranoid about “what if the medications has no effect?” so you’re saying that’s impossible? because that’s what my doctor said.

and also just curious about the eat with food thing with vemlidy…my understanding is that that’s only to prevent an upset stomach and so forth…I’ve taken vemlidy without food and I haven’t really had any worse side effects…but does it affect the effectiveness of the drug if I take it without food? that’s mainly what concerns me at this point.

Thanks again!

Dear Joseph,

I’m not a physician, so I defer to your caregiver about whether tenofovir needs to be taken with food. A quick Goggle search implied that food is not needed, but I really suggest following the guidance you have received.

It is not “impossible” to have tenofovir treatment for HBV fail, but it is extraordinarily rare. Tenofovir (the TDF version that you are taking) has been on the market so long that the patent on it has expired, but I’ve seen only a couple of case reports that are clearly due to drug resistance. This is just a handful of patients compared to many millions for which it works very well. So in all practical terms, your doctor’s comment is correct.