Hepatitis B: Treatment Resistance and Monitoring - Gastroenterology and Hepatology

Recent hepatitis B screening?

Hello Dr.
Lin, I am a carrier of Hepatitis B.
I have been on treatment with ETV (entecavir) for three years.
In December and June of last year, my viral load was undetectable, but this June, the viral load was measured at 28.
However, the E antigen, which is currently positive, has a lower value than in December (indicating some improvement).
My ALT (GPT) levels were 49 in June and 40 in March.
I am currently engaged in strength training.
I would like to know if this indicates the development of drug resistance.
Thank you.

Gaitee, 20~29 year old female. Ask Date: 2017/06/21

Dr. Lin Minghui reply Gastroenterology and Hepatology

1) Hepcludex is used for chronic hepatitis B, and the chance of developing drug resistance is very low.
2) GPT: 49 indicates elevated liver enzymes; besides hepatitis B, other possible causes such as medications, infections, or non-compliance with medication should be considered.
3) The viral load was previously undetectable, and is now 28.
It is recommended to monitor this, as sometimes the testing standards differ; although it is elevated, it is not excessively high, so follow-up is advised.
4) For patients who are HBeAg positive, it is recommended to initiate antiviral therapy until HBeAg seroconversion occurs, followed by an additional year of supportive treatment.
5) In summary, follow-up is recommended; the likelihood of developing drug resistance is low, and it is advisable to monitor clinical symptoms, liver function, and viral load.

Reply Date: 2017/06/21

More Info

Hello! Thank you for your question regarding Hepatitis B treatment and the potential for drug resistance.
Based on your description, it appears that you have been on antiviral therapy for Hepatitis B (likely entecavir, known as 惠立妥 in Taiwan) for three years. Your previous tests indicated that the viral load was undetectable, which is a positive outcome of the treatment. However, the recent detection of a viral load of 28, despite a lower E antigen level, raises some important considerations.

Firstly, it is essential to understand that the development of drug resistance in Hepatitis B treatment can occur, particularly with long-term antiviral therapy. Entecavir is generally considered a potent antiviral agent with a high barrier to resistance, but resistance can still develop, especially if the medication is not taken consistently or if there are underlying factors affecting its efficacy.

The fact that your E antigen (HBeAg) is still positive, albeit at a lower level, suggests that the virus is still replicating to some extent. The decrease in E antigen levels is a good sign, indicating that the virus may be becoming less active, but the presence of any detectable viral load is concerning and warrants further investigation.
Your liver function tests (GPT) being in the 40s to 49 range are relatively stable and within a manageable range, but it is crucial to monitor these levels closely, especially in the context of your viral load changes. Regular monitoring of liver function and viral load is essential in managing chronic Hepatitis B, as it helps to determine the effectiveness of the treatment and the need for any adjustments.

In your case, the detection of the viral load does not automatically indicate drug resistance, but it does necessitate a thorough evaluation. It would be prudent to discuss with your healthcare provider the possibility of conducting a resistance test, which can identify specific mutations in the virus that confer resistance to antiviral medications.
Additionally, lifestyle factors such as your commitment to weight training and overall health can positively influence your liver health. However, it is essential to ensure that your exercise regimen is balanced and does not lead to excessive strain on your body, particularly your liver.

In summary, while the presence of a detectable viral load could suggest potential resistance, it is not definitive. Continuous monitoring, possible resistance testing, and close communication with your healthcare provider are crucial steps to take. If resistance is confirmed, alternative antiviral therapies, such as tenofovir, may be considered, as they have a different resistance profile and can be effective in managing Hepatitis B.

Please ensure that you maintain regular follow-ups with your healthcare provider to monitor your condition closely and make any necessary adjustments to your treatment plan. Your proactive approach to your health is commendable, and staying informed is key to effectively managing chronic Hepatitis B.

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