Two years after taking TAF

Dear experts,
I started taking TAF in May 2020. Back then my viral load was over 8 x108 IU/ml. Last week, my blood test showed that my viral load is 3 x 103 IU/ml. The viral load has dropped significantly, however rather slowly. My body seems not responding effectively to TAF as reported. Also, TAF is quite expensive in China and it costs me 90 USD/month. I was wondering can I switch to entecavir which is much cheaper and perhaps has a better effect on my body. Is it safe to change drugs? I am afraid of drug resistance if I stop TAF. Would entecavir cause kidney issues in long run? Could anybody give me any suggestions? Thank you very much.

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Hi Jimmy, in general there shouldn’t be any problem with you switching from TAF to entecavir (ETV). But is tenofovir (TDF) available for you as well in China? There aren’t any food restrictions with TDF as there is with ETV (you have to take ETV on an empty stomach so can’t eat 2 hours before or after taking the drug). Since you’re a man, the risk of bone loss is much much less than a woman. The risk of kidney disease with TDF is only an issue for someone with an underlying kidney disease. But if you prefer ETV that’s fine, too. Hope others jump in with their experiences and thoughts. Always, Joan

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Hi jimmy
I had to switch from TAF to Entercavir because of kidney issues, later discovered bone loss leading to fracture in my spine. No previous kidney issues.
I’ve had no issues at all switching. I wish I had started on Entercavir.
I think the drug resistance is only a worry if you miss tablets or stop taking antiviral altogether.
I could be wrong.
Hope you are under a doctor.
Blessings

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TAF is still the best choice for high viral-load immune-tolerant patient with very good safety profile. Unfortunately, not everyone can reach undetectable viral load level within 2 years, but it will eventually. There is no problem of switching to ETV for cost-saving purpose, but this is not your reason, right? There is generic TAF in China, which should save you a lot of cost. To achieve a faster viral clearance, you might want to talk to your doctor about the possibility of using a combination pill. We have a Chinese-speaking hepatitis community. PM me if you want to join.

Hi Jimmy,

HBV DNA response in some patients is slower and takes longer to become unquantifiable (< 10 IU/mL). This is not a failure of TAF and will not likely be any better with ETV or TDF.

Your current viral load of 3000 IU/mL is low. How about your ALT and HBeAg? Are you being compliant with the dosing regimen for TAF?

There are no safety issues or effect on overall efficacy with switching from TAF to TDF or ETV. So if the cost of TAF is an issue you should not feel nervous about switching to one of the other drugs which are off patent.

As Joan has mentioned, you should consider TDF as another option to ETV.

Best regards,

Hi @Jimmy,

I agree with the comments here, but also want to recognise how much the virus is being suppressed in your case. You have experienced more than a 500,000-fold decrease in your viral load, less than 2 parts per million! That we can get the virus levels down this low does mean it’s working, but, as with anything, it takes a lot more effort and time for clearing the last few bits. It is normal to take this much time to reduce levels further on antivirals.

Yours sincerely,
Thomas

Hi Jacki,
Thank you for your reply. Now, I do not feel too bad after knowing not everyone can reach undetectable within two years. From literature, TAF is so far the best drug for hep B. For me, cost is an issue. Though, there is generic TAF in China, many hospitals only provide Gilead TAF for patients. It seems generic TAF is not widely accepted by the hospitals and the public so far, which is different in the case of ETV.
I would like to join the Chinese-speaking community.

Hi Thomas,
Thank you so much for creating this great platform for asking questions and discussing issues. The virus has dropped significantly, and I also feel better since starting the antivirals journey two years ago.
I still remember two years ago how much I was struggling and self-debating whether to initiate the journey (The lifelong journey). It was you I made the decision! Now I am in a better hand. Thank you again. I would like to take the generic TAF, however, there seems to be some trust issue with it. I do not know whether I should give it a try.
Thank you.

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Hi Jimmy

Which city are you in? In Beijing the BARACLUDE ETV costs around 84.5 USD/month. Not much difference to 90 USD. With social health insurance coverage, I need to pay around half of that amount.

Hi bloke,
I am in Nanjing. 84.5 USD/month is almost the same, I do not think it is worth the effort of changing in this case. I will consult my employer again next week to see whether my insurance covers the cost even though is partial.
Thank you.
Good health.

Hi Jimmy

84.5 USD is for the Baraclude brand. ETVs made by domestic brand should cost much less.

In Beijing if you have commercial health insurance on top of the social health insurance, you can get additional reimbursement after the social health insurance covers partial of the 84.5 USD. But the thing is that not every employer offers the commercial health insurance and I don’t know if an individual is able to buy the commercial policies.

Thank you so much for the kind words, @Jimmy. I’m very happy to hear that you are feeling well and are in a better situation. I’m also glad that I had some small contribution to this. Really great to hear :smiley:.

TT

Hey Jimmy, would you mind sharing your ALT/AST when starting TAF, and the viral load drop rate by month(s) in the past two years? This will provide more information for people to understand the case.