Patient: We have been married for two years and are planning to get pregnant in 2013. When we met, my wife told me she had hepatitis B. At first my mother disagreed and my father agreed, but after my father and I worked together to convince my mother, we got married. Now the whole family is very happy. Now my parents are slowly getting older, and my mother wants to hold her grandchildren soon. Basic situation: female, 28 years old, major triple-positive, taking medication for 6-7 years, not turned to minor triple-positive, but the viral DNA has been undetectable, liver function is normal, now using Adefovir. Male, 31 years old, with antibodies to hepatitis B. Based on the current situation, I have the following questions, please ask the expert doctor to solve them, thank you! 1. Is it possible to get pregnant? 2. Should I stop or change my medication? How long can I get pregnant after stopping the medication? 3. how should the woman cope with the increased burden on her liver after pregnancy? Which tertiary hospital in Hangzhou, Zhejiang has more experience in this situation? Yuan Gang, Department of Hepatology, Ningbo Second Hospital
A: If you want to get pregnant, you need to switch from adefovir to telbivudine or lamivudine. I don’t know if your loved one has used lamivudine drugs before, but if she has not used and/or has not developed resistance to lamivudine and telbivudine, she can directly switch to another drug. If hepatitis is present, it is generally due to the increased burden on the liver after pregnancy, which can occasionally occur in some healthy pregnant women, rather than due to liver damage caused by the virus, and can be treated with hepatoprotective drugs that can be used by pregnant women, such as EzanFu. The liver damage is not caused by the virus. Professor XX from Zhejiang Medical College in Hangzhou has had more experience using lamivudine to treat pregnant women with hepatitis B major triplets. I wish your family happiness and health!
Patient: Thank you very much, Dr. Yuan, for your kind answer! My wife had used lamivudine before, and then switched to it after her titer went up. My wife had been on lamivudine before, but the titration went up and then I changed it. I have never used tibivudine and I have seen some feedback on Professor XX from the internet, so I feel that I should find Dr. XX right. I will go to Dr. XX years ago to see him. Since I found out my girlfriend had hepatitis B before we got married, I decided I wanted to live with her and have children for the rest of my life. And now with all the kind help from the doctors, I feel more confident! Thanks again!
A: If this is the case maybe switching to lamivudine or telbivudine would not be a good choice. The reason is that these two drugs are in the same class and cross-resistance exists between them, which means that lamivudine your loved one has had resistance before, and then switching to lamivudine or telbivudine has a very high chance of rapid resistance. It is advisable to switch to telofovir, a drug that is not yet approved for hepatitis B treatment in China, but can be bought, at your own expense, at a cost of about nearly 50 yuan a day. 300 mg is taken once a day.
Patient: So which abbot in China has more experience with tenofovir and can Professor XX? Thank you!
A: This drug is used in the United States for anti-HIV treatment among pregnant women with AIDS and was found to have no effect on pregnant women and fetuses, so the FDA classified it as a class B drug, which means it can be used for pregnant women. However, pregnant women should not breastfeed after taking the drug. If you can buy this medication directly there, you can switch to it directly. Take it for six months before you get pregnant. Keep taking this drug orally during pregnancy, and after the child is born the mother can switch back to taking Adefovir without breastfeeding. At the same time, the child should receive one injection of hepatitis B immunoglobulin and one injection of hepatitis B vaccine on the day of birth, and then one injection of hepatitis B vaccine at 1 month of age and another at 6 months of age. This makes it almost impossible for the child to be infected with the hepatitis B virus. It is not necessary to decide which doctor to go to. This plan should be the best option for your loved one.
Patient: Thank you very much for your answers and valuable insights! So careful! In the near future, we will go to the hospital for a complete check-up and start the pre-pregnancy preparation. Also, I would like to ask, which domestic source of Tilofovir can guarantee that it is a regular drug? Thank you!
A: You can consult your local hepatologist, who is usually in contact with Glaxo Pharmaceuticals. Through them you can find out exactly where to buy this drug.
Patient: It is said online that tenofovir is available in India and Hong Kong. Is there a difference in efficacy? Thank you!
A: This drug we are now generally used in the treatment of AIDS, this drug is now the state is free supply. It is now used for the treatment of chronic hepatitis B. It is an imported drug produced in South Africa by the U.S. company Gilead, which is now commissioned by Gilead to sell it in China for the treatment of chronic hepatitis B. So you just have to contact Glaxo through your doctor. So you just need to contact the business department of Glaxo through your doctor to buy the imported drug.
Patient: Hello, Dr. Yuan! We went to see Dr. XX today. He said that we should not take Ader alone, but combine it with Lamy to prevent mutation (now it is 7 years of Ader alone and 2 years of Lamy before that). Also, told us to stop the Adder when we are pregnant. Two questions, 1. someone said that the order of taking the medication is to take lamis alone after resistance, take ade alone until resistance, then ade plus lamis? Or should I listen to Dr. XX and not take Ader alone? 2. Dr. XX said to stop the medication when I get pregnant, so I am worried that Ader will cause problems to the baby? Please advise Dr. Yuan! Thank you!
A: My opinion is as above. As for the first use of lamivudine after the emergence of resistance since 2007 is directly added to the treatment of adefovir, rather than change the drug, because the change of drug can easily lead to adefovir resistance, you are not resistant to the drug is considered lucky. The reason for stopping the drug when you are pregnant is that you were unknowingly pregnant and took a measure of last resort out of a desire to strongly continue the pregnancy, and there are no studies to support whether it will affect the fetus. So I think the regimen I recommended before should be the safest, at least according to the current clinical study data.