AFP? need some advice

Hi Everyone

I am a HBV carrier(was non active 5 years ago now i don t know)
Any way havent had a bloodtest a long time because the docters told me that my desease wasnt that serious being inactive and all.
So they did a blood test

AST 71
ALT 45
AFP10.1

SOOOOOO i worried because of the afp

after 3 months I v had another blood exam and this time it was

AST 46
ALT 40
AFP:9.8

Went to he the hospital and had US en the fount nothing on it.
But i am still worried like hell because of the AFP
MY question is is it often that a hbv carrier has a afp this high? does it meen cancer or cirrhosis
I am scaret s...tless

[Yasin76]

Anyone ? Pls an answer.. i can t even sleep..
Additional info is i am a hepatitis carrier for 19 years. I am a 28 year old male.

[stef2011]

to know if you are inactive you need hbsag quanti less than 500iu/ml and hbvdna less than 2000iu/ml, all the rest is cronic (chronic)

Any way havent had a bloodtest a long time because the docters told me that my desease wasnt that serious being inactive and all

ignorants, they said same thing to me, ended up with cirrhosis

AFP has no meaning anymore, it was too poor as a HCC marker so now it is not used anymore in updated centers, it just rise with active hbv

alt, ast, afp no meaning if alone, you have to take all tests

the only test you need now is fibroscan or biospy to know where your liver damage is now, at 28yo it is probably no damage, all blood tests have no meaning for liver damage for you now

[stef2011]

so look for the most updated center in ur contry or close to ur country for:

hbsag quantification by abbott architect or roches hbsag quant
hbvdna pcr, with lower range sensibility 6 or 12iu/ml

most important of alll fibroscna or biopsy (you can skip hbsag is you dont find it)

as to therapies at ur age interferon+alinia is the best one but again you have to look for a good liver doctor

[Yasin76]

Yeah i am scheduled for a fibro scan after 2 weeks in my town here in belgium...
Tnx stef your an angel m8. The ultra scan showed nothing the liver looks quite good on the ultrascan but i have a shortage of vitamine d. And bilubirin is 1.40.

I hope my liver doctor is a good one. I don t want this desease to be my grave.

[stef2011]

a shortage of vitamine d.

95% of hbvers have low vit d and this is common on all cronic (chronic) viral infections.take supplements plus sunbed because it increase immune response, levels higher than 50ng/ml are good

belgium is super for hbv, as all european countries are!
you will find full coverage of the newest tests/drugs

the best therapy is immune modulators: interferon+alinia (alinia off label)
antivirals are ok only to reverse liver damage but totally ineffective on virus so never use them unless you have severe livwer damage

i am following a researcher in your country, Prof K De Meirleir in Brussels in CFS forum, he is making a trial of gcmaf at his clinic:
Clinic Himmunitas
De Tyraslaan 111
1120 Neder-Over-Heembeek
Tel: [phone]
Fax: [phone]
Email: ***@****

he is the most advanced researcher on cronic (chronic) fatigue syndrom (syndrome), a illness where immune system stops working and many envelopped viruses get active at high titers, all these viruses are similar to hbv, so gcmaf might work on hbv too.
the main virus thought to make CFS is XMRV, Xenotropic murine leukemia virus-related virus (XMRV retrovirus), gcmaf is proabbly clearing this virus on many patients on the trial

the problem is i dont think he will ever accept an hbv patient.....anyway they are getting good results and clearing viruses with gcmaf(they just started trial less than a year) and it would be great if you can get some info on this gcmaf and the trial at himmunitas and if any chance to try it

this is the CFS forum link and some gcmaf patients on trials
http://forums.aboutmecfs.org/showthread.php?6019-GcMAF-for-XMRV-Gc-protein-derived-macrophage-activating-factor-anyone-taking-it/page85

[stef2011]

let us know ur results:
hbsag quant in iu/ml
hbvdna in iu/ml
fibroscan
hbeag

[Yasin76]

I m gonna ring them on monday.
I will get informed about the treatment and keep you updated. 80 km is not that far.
So i shouldn t worry about the afp?

I cant thank you enough..

[stef2011]

keep in mind that is a non profit clinic, Prof K De Meirleir is ultra busy and travels around the wrold to study patients, so just try to convince them although probably the answer will not be yes
in CFS forum they told me maybe an inquiry by a liver doctor or researchers might be successful so in april maybe i will try to convince them by researcher in pisa and dott ruggiero biggest gcmaf researcher in europe

there are also other laboratories making gcmaf and doctors, check in CFS forum, but i think this one is the most serious and also the GCMAF source the best/cheap

[stef2011]

afp is normal, abnormal when >10 but it doesn t mean hcc it increases with active liver inflammation

as to HCC the most important is a good sensibility ultrasound machine every 6months.the best HCC marker is golgi protein combined with US but probably not available yet

as to ur situation let us know although i am sure u have very good doctors in belgium

[Yasin76]

Allright i keep that in mind. Your advice at this point was more important for than gold.
Doctors are indeed very good. Hopefully they will have very positive news for me.

[Yasin76]

Hi

Is it possbile for inactive carriers to have liver inflammation. And a mild raise in afp.
How great are the chances.of getting hcc for me?

[stef2011]

Is it possbile for inactive carriers to have liver inflammation. And a mild raise in afp.

no but it was impossible to know who were inactive carrier in the past, ony now with studies on hbsag quantification we know how to distinguish cronic (chronic) carriers and inactive carriers, and we can also know those who are clearing the virus

only those with:
hbsag<500iu/ml and with much less sensibility 1500iu/ml are really nactive carriers
hbvdna<2000iu/ml
alt<30
fibroscan no inflammation or fibrosis
biopsy with cccdna quantification can of coruse confirm inactive carrier and even distiguish those who might safely stop antivirals therapy

all this research was made in italy by dr brunetto in pisa mainly on genotype D hbeag negative, but i have seen that many other studies have been made around the wrold on other genotype so it might be the same also for asians genotypes B,C
A genotype might be more similar to D than B and C.genotype A and D are the most common in europe/mediterranean area and D reaches turky, india, pachistan

the last two, alt/fibrosis, can be due to high meat, high fat, unhealthy life style and diet too, not only due to virus so the first 2 parameters are more imporant

[stef2011]

the other way to know for sure you were continuatively inactive is/was: alt and hbvdna checked every 3 months and continuatively normal

And a mild raise in afp.
meaningless anyway and normal on active inflammation, about 40% HCC have normal AFP and almost all active hbv have rises in afp
lately they found more useful AFP as indication of active inflammation rather then HCC, golgi protenic HCC marker studies were made in italy in milan and other cities so it may be available in HCC centers in italy, i dont remember sensibility but it was very high

but if you have no focal lesions on US there is no HCC, if you want to be 100% sure make contrast tomography but i have regressed cirrhosis and nodules and researchers are only checking by US because other checking methods make damage by the contrast dyes and radiation

How great are the chances.of getting hcc for me?
very low like 1-5% and the way to decrease risk even more are:

bmi less than 22
glucose normal/no insulin resistance
hbvdna undetactable
normal alt/ast
reduction of hbsag and hbxag

all these weakens virus and in vitro reduction of hbsag 76% regressed liver tumors

hbv infection is not the highest risk for hcc, the highest risk is diabetes (i don t remember exactly but something like 30% risk) and glucose imparment.glucose/insuline resistance seems connected with hbx which promotes HCC

[Yasin76]

Stef. You are my new hero.
The internet is written full of crap. It scares the s...t out of me. The insecurity is what a man can cost him his demise.
I had no idea how serious my desease was..
Again and again tnx for the info..

[Yasin76]

Hi,

I v had the fibroscan...
The strange thing is the medium probe read 6/kpa
And the xl probe read 16/kpa.
But the xl probe had a hard time reading so i don t know how accurate it is
according to the nurse who performed the procedure( she didn t know what she was doing) i have f3 fibrosis...
GREAT..What do do now?


I am hbv active with 13000...of those ******* in my blood.

[stef2011]

fibroscan has only one result of the 10 readings, what is the eaverage of the 10 readings? 6 or 16kpa and what is the ultrasound result?

fibroscan and US made together are better

[Yasin76]

Actually i don t know about the ultrascan. I don t think she did a ultrascan.
As for the fibro scan. I had 2 probes examine me.
The xl did get a fix on my liver. So she used the medium wich was an average of 6 kpa
The again she tried the xl. It still had a hard time reading the liver so she had some reading wich had an average of 16 kpa.
She told me i quote. "I don t get a fix but i have some reading it will be sufficient"
The examination took less then 10 minutes.

[Yasin76]

I mean the xl dit NOT get a fix on my livzr the first time. Typo

[Yasin76]

I am also scheduled for an mri after 2 weeks.

[Yasin76]

This desease was suppose to be benign. Unimportant. I hope there is a good treatment ro seroconvert

[stef2011]

if she said ur final result is 6kpa you have no fibrosis (16kpa is cirrhosis 100% if alt less than 200 and not obese and had no alt flares higher than 200 lately)

MRI is better because we suspect HCC so it will clear everything about hcc

[Yasin76]

I don t understand. So there is a chance i have hcc.

[Yasin76]

The mri was ordered a month ago before the ultrascan or the fibro scan.
I don t understand how the hell can i progressed this much.
I am so scared, i am gonna get married this year.
Pls tell me this cant be happening

[Yasin76]

The medium probe was for ordinary people
That read 6 kpa
The medium xl was voor obese that read 16 kpa.
I am 84 kilos en my height is 1.78 m
So i have no clue.
The professor said that it was 16 kpa.
The nurse that took the exam had trouble reading my liver with the xl probe. shie tried 4 times on different places.
I am scared ********.

[stef2011]

I don t understand. So there is a chance i have hcc.

all people carrying hbv or diabetes has a chance of developping liver cancer and liver must be monitored every 6 months so that if/when develops it can be treated

I am 84 kilos en my height is 1.78 m
you must lose weight being over weight worsen chances of cirrhosis and liver cancer vs inactive disease.the safest bmi is between 20-22

The professor said that it was 16 kpa.
yoour fibroscan was 16kpa, are you sure?if so high you must start therapy and be sure about correct reading because fibroscan sometimes cannot read obese

[stef2011]

as i said before you must be sure if ur fibroscan was 6 or 16 and repeat again for security because 16 is cirrhosis (i had a pick of 16.2kpa for my liver but oct 2010 regressed to 9kpa)

in case of cirrhosis entecavir is the best drug to reverse it if you get about bmi 23 because in obese liver worsen even without hbv

[Yasin76]

Actually i am not sure.

The nurse had a lot of trouble finding the place between my ribs en she played with the probe all the time.
When i asked about the kpa she said with the medium probe it s 6 and with the xl its 16.
I don t know. i crying my eyez out. How can this be. i m to young for this and i will start treatment

[Yasin76]

My bmi is 26.
I don t think that is considered obese. So the medium probe should be correct. I dunno.
I am scared.

[stef2011]

i was 25 and have fatty liver, i also thought 25-26 is ok but it is not at all on us with liver disease.the bmi with longer life rates and with fibrosis/cirrhosis regression is medium 23

you don t have to be scared we re all on the same boat, just recheck fibroscan, possible losing some weight slowly (max 1kg per week) and possibly by excercise and recheck it

MRI is too much for monitoring, once they clear this time with MRI and find nothing you can monitor every 6 months by utrasound

for example i am also monitored every 4-6 months by US because i am in the hi risk hcc ptients and will have one mri this year too

[Yasin76]

I understand.

Still i don t get it. How is this possible.
I don t even have 1 symptom or i don t feel sick. i always considered myself to be very strong against deseases.
The professor told me that i had mild fibrosis today, he said you are F3. Don t worry to much.
After the mri everything will be clear.
Was he lieing to me.
How can i be calm a month ago i had no worries i was happy because i just got engaged bought myself a house.
Look at me now. i can t even tell my fiance i am lieing in her face.
Stef you v been a great help. IF i die young then so be it. i just can t believe at this age...

[stef2011]

I don t even have 1 symptom or i don t feel sick. i always considered myself to be very strong against deseases.

hepatitis, cirrhosis and liver cancers are called the silent killers, you dont feel them or see changes in blood tests most of the time until death is very close

[stef2011]

The professor told me that i had mild fibrosis today, he said you are F3.

are you sure he is good, f3 is severe fibrosis and very close to cirrhosis.mild fibrosis is f1-2 and treatment must be started at f2.but you don t have to worry because fibrosis can be reversed very fast if it doesn t reach cirrhosis
on cirrhosis the process is slower and require about 3-6years, not too advanced cirrhosis and bmi 23

[Yasin76]

That s what he said.

In dutch he said you have mild fibrosis. F3. So its best we start treatment
BUT i have to tell you something
i dont know the 16 if it is in kpa or anything else but as i searched on the internet only kpa is possible

[Yasin76]

That s what he said.

In dutch he said you have mild fibrosis. F3. So its best we start treatment
BUT i have to tell you something
i dont know the 16 if it is in kpa or anything else but as i searched on the internet only kpa is possible

[Yasin76]

By the way.

She only got 5 readings with the xl probe so not the ten.
So i dont know how this can change things

tnx stef

[Yasin76]

I asked my doctor one more time.
They took de avg from 6 kpa and 16 kpa what makes 10 kpa.
Tjat s why he said f3
Pls advise

[stef2011]

10kpa needs treatment, it is too high very close to cirrhosis

also HCC is increased with fibroscan values higher than 8kpa or 10kpa, you cannot wait to have it higher

best therapy to reverse it is:
test for polimerase mutations to be sure you have no lam mutants
entecavir mono or comboed with alinia or interferon

if you cannot check for polimerase mutations better use tenofovir

[Yasin76]

Yes i will get treatment but my doctor is waiting for the mri and maybe a liver biopsy.
After then he wants to decide wich treatment i have to go throw.
I m getting married this year, and my desease is welcoming our marriage, such fun...
I hope the treatment will svr me and regress the damage.
HCC can also occur and if it does i m screwed. But i v had an ultrasound wich came back normal so i hope the mri has also the same results.
I also had an appointment with a homeopathic doctor and he gave me some drugs. Said it would support my liver.
I hope everything will work out okay. My doctor told me it doesn t look that bad just have faith and let uss do the rest.
I hope he is right

[stef2011]

and maybe a liver biopsy.

i will avoid this, biopsy makes damage to the liver infact it is not allowed to do a biopsy in less than 3 years one from the other, you already know from fibroscan that damage is high i would check with biopsy only if you are willing to avoid treatment at low fibrosis, at this point it is useless since we already know you have to treat and you have to lose weight anyway

I hope the treatment will svr me and regress the damage.
if you lower weight regression of damage is sure but svr is possible only in interferon comboes and only for about 30% people

I also had an appointment with a homeopathic doctor and he gave me some drugs. Said it would support my liver.
avoid them if you make treatment they interfere with drugs, you can do hepatitistechnologies, which are fda approved for fibrosis/cirrhosis, only when interferon is not used and only when hbvdnais und, all the rest s probably wasted money, what are the homeo drugs?

I hope everything will work out okay. My doctor told me it doesn t look that bad just have faith and let uss do the rest.
looks like you have nothing and will regress fibrosis in 1-2 years but you have to lose weight that is the first enemy which works with hbv, latest research showed that most low bmi hbvers dont develop damage

[Yasin76]

Stef

thank you so much.
I will follow your advise.
Maybe i will retake the fibroscan.
But still i am gonna fight it with everything i can.
My bmi is now 25.
I was 73 kilos 2 years ago. then i began to eat pizzas and doner kebabs and frites.
And i am a spagettiolohic. i gave up on all of them.
No i eat honey, yoghurt drink coffee. And the weight is just flying off

[stef2011]

then i began to eat pizzas and doner kebabs and frites.

being an italian i was the same, all pizza and pasta...unfortunately this might henance methabolic changes induced by hbv

change to black rise and blueberries fruit
http://www.ncbi.nlm.nih.gov/pubmed/18598166

[Yasin76]

Friends,

i wanted to ask a question.
Stef(tnx for everything my friend you have been a big help) told me that high bilirubin level is end stage liver disease.
This of course scares the **** out of me.
Here are my test results.
Afp: 7.6 ui/ml(range 7)
Sgpt: 42
Sgot : 30
Albumin: 5.3(range 3.5 - 5.2)
Bilirubine total: 1.93(range 0.2 - 1.2)
Bilirubine direct: 0.4(range 0.1 - 0.3)

Had a fibro scan done it was between 6-16 kpa showed F3. ! don t know how reliable it is)
Ultra sound came back normal(2x done in 1 month)
Mri showed no abnormalities.
I have no symptons what so ever or any fatigue.


Doc scheduled me for a biopsy tomorrow.

I am carrier for 19 years.
i am 28 years old.

Please i ask you if anyone has additional information or experience regarding this matter I am so worried...

[Yasin76]

today i received my new bloodresults.
alt is 35
vit d 39
cholestorol 185
hbvdna still around 1000
but my afp has risen to 10.4?

[stef2011]

between 6-16 kpa showed F3

what is the final number which is the media of all reading?

F3 is precirrhosis so it is useless to make a biopy which makes damage to the liver, especially if you are f3, remember biopsy can be deadly especially to damaged livers..although very rare somebody dye on biopsy......i wouldn t make it sne it is clear you must start treatment anyway, so why make damage to the liver, what do we get from a biopsy.....damage?

Ultra sound came back normal(2x done in 1 month)
Mri showed no abnormalities.

so no cancer.any fatty liver?i guess not since they didn t say

since you are 28yo interferon would be a good choice together with nitazoxanide

vitamin d is 39ng/ml or different unit?take supplements 5000iu daily for a month and see if you can get it to 60-80ng/ml

[stef2011]

see answer on focault post, another good strategy is start with tenofovir and then add interferon after 6-12 months of hbvdna undetactable

in your case this is good because you need to repair liver a little and tenofovir will help with this and then interferon can eradicate hbv or allow to discontinue tenofovir if it fails

see also all our posts about fibrosis and how i regressed from 16.3kpa to 6.3kpa in less than 1,5 years, without supplements and healthy life antivirals/interferon only are too slow on liver repair, they take years

[Yasin76]

hey steffano :-)

i already had the biopsy wich came back F0 so dont know how accurate that is but is showed mild active inflammatory and no fibrosis. fibroscan was 16.6 moderate i don t know why but had to do with technichian not finding the right spot i guesse. 9 months ago my first afp test showed 10.1 then 9.8 then 7.6 then 7.1 and now 10.4 wich is awfully disturbing.

i am already on supplements :) and black rice and bleu berries.

[Yasin76]

fibroscan showed cirrhosis. the machine was right it is the doctor that cannot intpret the results.
on the other hand liver biopsy showes no fibrosis what so ever. 2 weeks ago i asked you if it is possible that a biopsy can be wrong 4 stages you answered no it is not...

[stef2011]

ok i remember now......so you are just on supplements for now until lambda or gcmaf show up

afp is normally little elevated on active hbv and inflammation, your result has nothing to worry about.