Looking for advise switching from TDF to Entecavir

Living With Hep B Treatment and Monitoring
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Hello, I want to thank you all for this community that we can seek answers and share experiences.
A little background about myself. I was born in Taiwan with HepB. I was treated with Lamivudine when I was 30y old due to the high virus load. I was on Lamivudine for 2 years, but virus has never gone undetectable. The doctor stopped the treatment. I later learned that it was a mistake. 5 years later, I had very bad symptoms and the bloodwork showed all my liver functions were out of range and virus load was off the roof. I was referred to specialist in Stanford. He started me on TDF and I have been on it every since. It has been almost 15 year years that I am on TDF. I tolerate the drug well, and show little side effects. All the lab tests are in the normal range, and virus has been undetectable over 12 years.
I am 50 years old now. Female, pre-menopause. Recent bone density showed the signs of bone loss. My doctor here in Idaho suggests me to switch from TDF to Entecavir. I wrote an email to the doctor in Stanford and he suggested to switch to TAF instead. I can’t really afford TAF since it is still a very expensive drug and my insurance won’t cover much.
I am wondering if anyone has switching drug from TDF to Entecavir, and if the virus stay undetectable.
Thank you very much for the support.

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Hi, my experience with Entecavir was not good. I was on TDF and then went off for a few years and I had a flare up. The doctor prescribed Entecavir and it did not reduce my flare at all. He then switched me back to TDF. 3 years ago I switched to TAF and it feels ok so far. I highly recommend finding a way to take TAF instead of Entecavir.

My insurance also didn’t pay TAF and I used Vemlidy’s Co-pay Coupon Program or a year until I switched to a new insurance. Just Google the program and you’ll find it. This forum doesn’t allow me sharing the direct link.

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Hi @ipingchen,
Welcome to the community. Yes, Entecavir can maintain your undetectable status. I was on it for a number of years before switching to TAF and never had any issues or side effects. I was undetectable throughout that period. It is also a little cheaper since it has a generic version. I was switched to TAF because my liver function fluctuated and never got stabilized, but my HBV DNA was undetectable. You should not have any issues switching. Thanks, Bansah1

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Hi @mew,
Welcome to the community and sorry to hear about your experience with Entecavir. Patients react to these antivirals differently. I never had any side effects when I was on it. You are among the small pool of people who did not tolerate it well. Glad to hear that TAF is working well for you. Best, Bansah1

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Switching from TDF to Entecavir is a significant decision, and it’s understandable to weigh the potential benefits and risks carefully. From my experience and understanding, many patients who switch from TDF to Entecavir have successfully maintained undetectable viral loads. Entecavir is a potent antiviral with a good safety profile, and it is often used as an alternative to TDF, especially when bone density issues or other concerns arise.

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Are you a US resident with US insurance? If yes you can sign up for the copay card which pays 5k per year for the Vemlidy.

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Hi @ipingchen, I am also from Taiwan, currently live in the US. I am on TAF and had taken entecavir and TDF before. Insurance coverage for the brand name TAF is problematic in the US. Since you were on lamivudine, TAF is likely a better option to minimize the risk of drug resistance. There are several options to reduce the cost. You can email me at jacki@thica.com.tw or join our Taiwanese facebook group @ groups/hepatitis.taiwan 台灣肝炎資訊網, or our LINE group at http://line.me/ti/g/2F4wbrTC81 There are many of us with similar experience. /Jacki

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Thank you! I have asked to join the Facebook group.

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I am in US and with Blue Cross. I will look up the coupon for Vemildy. Thank you!

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Hi, I started with TAF, and my responses to the treatment was good with no side effects and undetectable HBV DNA. One year later, my DXA scan showed big increase in bone loss. I have since switched to Entecavir, and on it for almost two years now with no issues: undetectable viral counts and stable bone density. Hope this helps.

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Hi all,

I’m a scientist, not a patient so I cannot comment on the individual tolerability of entecavir vs TDF. However, the raw antiviral power of entecavir is actually slightly better than that of TDF, so as long as you tolerate it well (most people do), then you should have no problems. There are rare cases of resistance to entecavir, but those are primarily in patients who previously developed resistance to Adefovir. That seems irrelevant in your case as it does not appear you were ever on Adefovir.

John.

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Hello, I’m just an advocate here, but in my recollection there can be entecavir resistance with prior lamivudine exposure. Please discuss further with your doctor. Here’s a result of a study from a quick google search: Prior Exposure to Lamivudine Increases Entecavir Resistance Risk in Chronic Hepatitis B Patients without Detectable Lamivudine Resistance - PMC

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