Should I Change Entecavir does to1mg from 0.5mg daily?

Living With Hep B Treatment and Monitoring
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Hi, Thank you all for taking the time to read and respond.

In know I am hep B carrier 25+, but no medication. My AST and ALT are about 31 and 45.
In 2022. doctor tested virus > 100,000,000 and put me on Entecavir 0.5mg daily. The medicine worked well at the first 2.5 years and virus number was going down to 1,300 IU/mL. In end of 2024, the virus bounce to HBV DNA is 2,800 IU/mL from 1,300 IU/mL. Is that entecavir resistance? Now ultrasound and liver fibrosis are normal.
Some article said “Increasing ETV dose from 0.5 mg to 1 mg ETV treatment may provide an effective suppression of viral replication”; But some said it cannot help.
One liver specialist let me double does. Another liver specialist let me keep same does. He said he won’t worry if the number is below 3000 IU/mL.
Not sure if this work: Switching to or adding a drug with a different resistance profile: to switch to or add a potent antiviral drug to which the virus is still susceptible. Tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) are typically the preferred options, as they have a different resistance pathway and a high genetic barrier to resistance.
| I’d really appreciate thoughts or suggestions.

I’d really appreciate thoughts or suggestions.

 Yrs	            2023 yr     Sep, 2024   Dec.2024  Feb, 2025  May.2025

HBV DNA QNT 12,488 1,390 2,780 1,770 1,240
HBV IU/ML LOG 4.1 3.14 3.44 3.25 3.09
AST 16-40(25) 24 29 39 28 31
ALT 0-55 (25) 39 43 50 36 40
I’d really appreciate thoughts or suggestions

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Hello @Cricketgre

Thanks for sharing your history.
I’m not an expert but we have others who are. They shouldn’t take too long to respond.
Hepatitis B can be so confusing sometimes.

@ThomasTu @Bansah1 @availlant

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Dear @Cricketgre ,

These fluctuations are not resistance but wobbles from test variation. Persistence of HBV DNA on NUC therapy is known and this is likely due to individual variations in the rate of breakdown of the drug in the liver. Maintenance of HBV DNA at these low levels will prevent the development of liver disease but ultimately, suppression of HBV DNA to undetectable levels will provide a better long term benefit in terms of lowering risk from developing liver cancer.

TDF and TAF are the same NUC compound except TAF is in a different prodrug configuration which improves selective accumulation in the liver. ETV and TDF/TAF have the same excellent resistance profile. This is due mainly to their ability to also activate innate immunity in the liver to help suppress cccDNA function. Switching between these two NUCs is of no concern for resistance.

In your case the I would suggest consulting with your doctor about switching from ETV to TDF (generic) or TAF (branded = more expensive).

@availlant

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