Personal opinion on to start antivirals or not

Hello everyone,

I know this question has been asked several times by a lot of people but as per my understanding each case of hep b is different so i want to know personal opinion of science experts whether to start antivirals or not? I am asking this because i am still on monitoring just because my ALT is normal but that doesnt mean virus is not active.
I really want to be my own advocate and prevent the carcinogenic effect of virus on my liver. Since i believe i got it an year back i still have good chance of antiviral treatment and prevent further chromosome damage and prevent more integration of virus.
Little bit about my condition. I am HbeAG negative chb with viral load of 16100 IU and normal ALT 18 and fibro scan was average 6.2kpa(not sure if this is bad). My doctor is meeting me in February and she really doesnt have a lot of time to even listen to me so i want to be prepared for my meeting.

Please give your personal opinion on this issue. I dont care the EASL norms or cutoffs. Pls state downsides of taking antivirals as well. Am i screwing my chances of functional cure by taking antivirals vs not taking?

Please help
@availlant @ThomasTu @john.tavis

Dear Ash,

I don’t know if you fall within the treatment guidelines or not (I am not a physician), but the nucleoside analog drugs Entecavir and Tenofovir are very safe in the vast majority of people. Starting to take them now will not reduce your chances for attaining a functional cure when the new drugs are approved. Many of the envisioned drug combinations will include Entecavir or Tenofovir, so the new treatments would most likely just add one or more new drugs to your treatment regimen.

There is a growing but not yet dominant opinion among HBV researchers that starting nucleoside analog treatment early would help reduce accumulation of HBV integrants into people’s liver DNA. The prediction is that that would reduce chances for developing liver cancer. I personally share this opinion.

I wish you the best.

John Tavis

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Thank you John!!
I had exact same questions when I met with Dr Robert Gish and he exactly shares same opinion of yours……

It really makes lot of sense!!!

Ash_Malhotra
Thanks for the good questions!!

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Hi @Nass

Did Dr Gish started you on antivirals then?
Honestly my doctor is too short on time and might dismiss my request to start antivirals but i really want to protect myself from chromosome damage and prevent HCC. What did he say?

Yes. I will be on med next month… Will start taking TAF.

FYI… you always have option to seek 2nd opinion if your doctor does not have time to convince you…or give you All available options…

It was definitely easy decision to go with Dr Gish’s recommendations over my Infectious disease (IDS) doctor…

Thanks

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@Nass Thanks a lot buddy. Just a question how to get second doctor? I tried calling hepatologist or GI specialist but they dont take me saying they need referral from Primary care or not accepting new patients.
I live on east coast and after calling several facilities i gave up.
How do you get a second doctor without referral?

@Ash_Malhotra

There are always lot of GIs and IDS doctors that won’t ask you a referral… Keep searching!!

Also check the hepb.org directory…

https://www.hepb.org/treatment-and-management/physician-directory/

Also Dr Gish can see you via Telemed…
Here is his site

Good luck!!

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