Hepatitis B

A 60 year old female presented to OPD with complaints of decreased appetite,nauseated all the time and retrosternal burning and epigastric discomfort from last several weeks Chief Complaints She has had similar complaints in the past too Vitals BP on follow up visit today was 160/100 mmHg S.Bilirubin Total - 8 Direct - 6.4 Indirect - 1.6 SGOT - 1460 SGPT - 1948 HBV Viral load - Significant, about 12900000 Physical Examination Pedal edema is not present Investigations USG - W/A - Hepatomegaly and mild splenomegaly Management I have advised her UDCA 450 BD, LIV 52 HB 2 TABS BD, GLUCON D, PPI + Prokinetic Please guide me whether tenofovir disoproxil fumarate 300 and tenofovir alefenamide 25, basic difference between these two drugs?

LikeAnswersShare

Reverse transcriptase inhibitor TDF has higher risks of bone and renal adverse events, and lower HIV RNA suppression rates, compared with TAF. If acute viral hepatitis B, don't Start antiviral treatment. Once antibodies HBV core antibodies IgM disappeared, can consider therapy.

Valuable opinion
0

Tenofovir alafenamide (TAF), is a pro-drug that can be absorbed quicker than Tenofovir disoproxel, and gets converted in higher levels of the active drug, tenofovir diphosphate, in hepatocyte cells.  Thus smaller doses is required to achieve same effect and it can protect against ill effects on kidneys and bones, decrease side effects. Tenofovir Alafenamide is better choice for treatment of Hepatitis B than disoproxel

Thank you doctor
0

This is most likely HBV reactivation. Start the patient on either Entecavir 0.5 mg or TAF 25 mg. Also do anti-HCV and HIV for the patient. Do an INR also as HBV flare may lead to ALF or ACLF. Do an USG Abdomen to look for any features of chronicity. Monitor LFT and INR serially.

Sir, USG W/A reveals only hepatology and mild splenomegaly. Anti HCV is non reactive sir. Will do the rest as advised and seek a gastro opinion too for her.
0

View 3 other replies

Tenofovir alafenamide is a pro- Drug than can be absorbed quickly than tenofovir disoproxel and converted in higher level of active drug in hepatocyte cells. Small dose gives long lasting effects and side effects are less common or decreased. Therefore TA is a better choice for Hepatitis B treatment. Rest continue treatment . Needs further investigation and evaluation.

Thanks Dr Sandeep Ghodekar
0

NEED'S .. TAF .. LIV-52 HB .. LIMCEE .. CLINICOPATHOLOGICAL EVALUATION WITH .. USG..ABDOMEN .. LFT ..

Thank you doctor
0

View 1 other reply

Fat free highcho cold home prepared soft food vit c direct high ursecol rest wait

I agree
0

Start tablet tinofovir , if renal function is abnormal then tenofovir alefenamide and if renal function is normal then tdf can use @

Valuable opinion
0

PT/INR of the patient

Diseases Related to Discussion

Cases that would interest you