help Pelease! Liver411

my911

I’m  aPatient of chronic hepatitis B and looking forward to your help.
In 1988, I was found out I have be infected HBV, HbsAg(+), but ALT is
normal. In September 2000, I was found out HBsAg(+),HBeAg(+),HBcAb(+)
and ALT 187 IU/L. After observed 12 weeks without any drugs, the testing
results were HBsAg(+),HBeAg(+),HBcAb(+), ALT 198 IU/L,and HBV-DNA (PCR) positive (6.5*10E6 copies/ml), so given lamivudine 100mg gd on 29
November. 4 weeks later after taking lamivudine, HBV-DNA level became
undetectable and remained negative for 20 weeks,12 weeks later after
taking lamivudine, ALT(-),HBeAg(-) and HBeAb became slight positive,16
weeks later after taking lamivudine, ALT(-),HBeAg(-) and HBeAb became
positive and remained positive. On 15 June,2001 (taking lamivudine 24
weeks),I was admitted to stopped taking lamivudine. But after 4 weeks,
ALT 90U/L,HBeAg(-),HBeAb(+) and HBV-DNA positive (6*10E6 copy/ml), so
given lamivudine 100mg gd on 18 June again. 4 weeks later after taking
lamivudine again, HBV-DNA became negative and ALT decreased normal level and remain to 18 April 2002. The serum HBV-DNA testing at month 8 of
therapy again lamivudine that shows positive (1.21*10E5copies/ml). On 25 June), the testing of HBV-DNA increase to 7.17*10E7copies/ml) , ALT 344 IU/L, HBeAg(-) and HBeAb(-).ALT increase to 71 IU/L but HBV-DNA decrease to 3.21 *10E5 copies/ml on 26 May. I am in good condition until April 2002. Now I have some symptoms such as fatigue and anorexia.Since 27 June, I had been taking and Iv some drugs to decrease ALT and yesterday  ALT was 98IU/L.  My physician and I think I have emergence of YMDD
variant, but can’t know which kind variant (YIDD or YVDD). I was suggested to use INF- alpha 300mU QOD.Whether is INF- alpha good for me?Whether should I stop taking lamevudine? If I stop taking lamivudine, Which drug should I take? I wish you can give me some advice about
my disease.

liver411

The chance is that you had a replapse after stopping taking the medication, and might have developed drug resistance mutant, which caused flare of transaminases as well; If I were you, I would contiune on taking of (3T) for the time being (unless serious ADR appears). If Lamivudine is topped, the mutant virus appears to die out and nonmutant virus replaces it again in the blood. It is said that the onset of resistance does not appear to be associated with severe liver disease (as bad as nonmutant virus). If I were you, I would contact Gilead, Inc. directly via its web based email system to get early access program of Adefovir in China. I knew several people contacted them did get the information about this program in his/her residing country. (but you have to contact them personally) Interferon alfa may help you reduce the ALT level or even HBV DNA load if you are fit in the "reactive" and "treatment" requirement, (ALT>100IU/L, HBV DNA<200pg/dl~566000copies/ml...), but you will probably have a relapse too once the treatment stops. Also, the doctor has to find out if your body and liver are strong enough to handle the side effect INF causes. You can try it under doctor's supervision and careful tests; Gilead's web site is: www.gilead.com and contact them first to see what they say.