Taking Antiviral BEFORE Infection / Diagnosis and Affecting Recovery?

Hi all,

I’m new, so apologies in advance if I miss something somewhere. This community seems great and welcoming, so I’m grateful to be a part of it now.

A few weeks ago, as part of routine blood work I tested reactive for HBsAg (and follow-up testing confirmed a positive reaction for HBeAg). Fortunately, I have no symptoms, the HBV DNA PCR showed an undetectable amount of virus, and the liver results came back normal. I was also vaccinated against Hep B as an infant, but I guess the efficacy has worn off since I didn’t test positive for any of the antibodies.

I’ve been taking Truvada (emtricitabine / tenofovir) for almost a year as an HIV prevention method. I’m currently 30 years old and tested fine last year when I got Hep B testing prior to starting Truvada. My hepatologist said the Truvada is likely the reason for an undetectable virus load now but it also means that my chances of going from an acute infection to a chronic infection are slightly higher, which worries me. He recommended I do not stop taking Truvada, so I will continue to do so. However, I am worried that continuing to take it is not helping my body, but I will continue to follow his advice.

Has anyone dealt with taking Truvada or Descovy, and then later becoming infected with Hep B? Will the Truvada make it significantly less likely my body will develop the antibodies needed to fight the virus? I should continue to take Truvada and hope for the best, right? This is all new and emotional to me, and I’m wondering how this will affect my social (severely reduced drinking, careful with cuts/wounds) and intimate life (with my current partner and/or others) if I become chronic.

Hi @kevin 1
I really empathise with what you are going through as a person who also went through the same feelings when I first tested positive for chronic Hep b. Unlike many of us, you are lucky to find the direction to the right forum ( hep b community) where your worries will adequately be addresed. The community also recognises your presence and contribution that’s why we sincerely welcome you to be part of us.
Moreover, since your questions are specific, they require specific answers and will be provided by those who qualify to do so in the opportune time.q
Regards
Kinoti.

Dear @kevin1,

Welcome to the community and hope you get the support you need here.

This is a great question and I’m not sure it has been investigated directly (as it would be quite a difficult study to conduct).

Possibly the closest analogue that has been well-studied is the use of entecavir/tenofovir for prophylaxis when HBV patients undergo liver transplants (with a HBV-negative liver). There are several studies (https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.23692 and Entecavir Monotherapy Is Effective in Suppressing Hepatitis B Virus After Liver Transplantation - ScienceDirect) showing that entecavir/tenofovir treatment prior to the transplant can lead to HBsAg-loss (>90% of patients).

This was seen even if 1) HBIG was not used or 2) there was still detectable circulating virus at the time of transplantation that the new liver would be exposed to.

In the bad old days before these antivirals, reinfection of a new organ with HBV was pretty much guaranteed. So my interpretation of these studies would be that the tenofovir in the Truvada should help the body overcome the infection (at least in theory).

This is obviously a different situation: for example, this might be the first time that your body has seen the virus (unlike these chronic HBV patients). It’s not clear in my mind if or how the Truvada would make it less likely that you clear the virus.

Definitely you should keep following your doctor’s advice and continue taking the medication prescribed to you.

Hope this helps,
Thomas

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