I’m 28 years old Female, I was born Hep B carrier, I’ve always been HBeAg-positive， my dad passed away at 33 cause of liver cancer. As my age grow I get more and more concern
I’ve been on medication for almost 3 years, before I move to uk, I was on tenofovir alafenamide fumarate tablets for almost 8 months? My virus went from billions billions to something like thousands with 3 month? I just remember my virus load was super high but my liver function has always been normal, the only reason I started taking meds. Was because 3 years ago, my right side waist and back was constantly feeling hot, it’s a feeling that I have to press on it to make myself feel better? Even till this day I still feel like here and there, especially if I stay up at night.
When I move to uk in 2023 Jan, I can’t really keep up with the first pill price wise, it’s around 60-70dollars every month? Cause uk has Free health care, so I checked myself in, and they prescribed me with tenofovir disoproxil film- coated tablets, 245mg, last time I checked my virus was almost 4/5months ago and it’s still 157 virus, ( I have to admit, these years sometimes I missed a dose or not taken on time and don’t take it with food)
I recently learned the term Low level viremia and I’m very concerned about it, as my family history and my virus still detectable.
My last liver function check was in oct 30th, ALt/AST show normal. My next appointment with dr would be Jan 2,
Can you guys please gimme some advice? Should I ask the doctor to do more check on me? And ask for combined medication to press the virus down?
and I’ve heard from some people I made a mistake taking pills when my liver function was normal, I had people telling me I should wait till it’s abnormal then that’s the best time to start be on medication so I’m very confused….
Try to see what genotype your virus is . C is pretty virulent . Even all your tumor factor is normal , ALT is normal , the virus will integrate into your telomere or a mutation on your CCCDNA. I had HCC 2-1/2 yrs ago detected to be on second stage . Liver resection and on surveillance . My doctor think I should lower my A1c from 6.2 to 5.6 or below . I am taking Metformin ( Dr recommend I take SGPL2 inhibitors but it may cause UTI . So I started low dose metformin . I need to lose weight another 5 lbs in addition to daily exercise. Good luck . Check your A1c and try to lose weight if you are overweight. Inflammation may contribute to HCC
So the standard dose of TDF for adults is usually 300 mg. 245 is generally used for children. I would recommend increasing to the full dose to see if that knocks the viral load down some more.
Hi @Uklife,
I am sorry to hear about your dad, and I acknowledge your concern. It can’t be a mutation if your viral load went from billions to thousands in 3 months. The only issue I can see potentially playing a role here is that you may be missing too many doses and not adhering to the instructions, which could definitely impact the viral load. I will encourage you to take your antivirals consistently and as prescribed. It is crucial. Have you tried anything for gas or bloating? You will be surprised by the impact of bloating and gas, especially on our ribs and midsection.
Have you had any liver imaging? If not, ask your doctor for an abdominal imaging. It should be part of your care, performed either once or twice a year.
These are just somethings to consider. Best, Bansah1.
It is normal that HBV DNA is low but still detectable even after years of treatment, particularly when starting with very high viral loads. Your viral loads are still decreased by 10 million fold. Additional medication is not necessary to limit liver damage - the main reason for taking antiviral treatment.
Different people will start treatment due to different reasons. In your case, your family history of liver cancer justifies treatment regardless of liver function. The antivirals will act to reduce your risk of liver cancer.
I forgot to ask him, how long should I monitor my virus load before I consider combine with other pills to keep it un detectable. Any advice on this? Thank you in advance
Great to hear that you got to talk to your specialist and that you got normal test results back!
Regarding your question, I do not think the guidelines suggest anywhere that anyone should take combination therapy to get your viral load down to undetectable. Happy for any @HealthExperts to suggest otherwise?
I think your HBV status is HBeAg +ve immune tolerant phase due to your billions amount of HBV DNA and normal ALT .
According to your concerns about low viremia and the chance of HBV integration to hepatocytes while some studies found that about half of HBeAg +ve immune tolerant CHB patients have necroinflammatory activity in their liver despite normal ALT. I agree with @ Thomas that there is no guidelines for the use of combination therapy among Tenofovir and Entecavir except for WHO guidelines 2024 for HBV management which suggest TDF+ Lamivudine (3TC) or TDF + Emtricitabine(FTC) where TDF or TAF is not available. If you want complete viral suppression (undetectable or lower limit of quantification) , the more you have higher HBV DNA levels especially > 9 log10 before treatment started, the longer times it take for complete viral suppression.There was study (Noureddine et al , Int Arch Med 2015) which showed that long term treatment with TDF up to 5 years in HBeAg +ve CHB patients resulted in improvement of necroinflammatory activity with HBV DNA suppression (< 69 IU/ml ) in most patients. I think you should maintain TAF treatment for at least 5 years and follow up HBV DNA periodically before deciding to use combination therapy. If you have good adherence and healthy lifestyle, you may finally have high opportunity to get completely viral suppression . I hope this may help you.
I’m starting to think the reason why I haven’t got it undetectable is because of how high it started I can’t find original medical report showing the amount, but I remember the doctor was saying it’s a very high number in billions range. I’ll take the advice try take the pills on time for more time and monitor the number to see if it’s going down!
