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After 16 week with Interferron + Simvastatin
Took 1st dose on 21 Oct 2011 and on 11 Jan 2012 HBV DNA not detected.  
Below is the lab history,                          

Date            13/9  20/10  21/10  11/11  16/11  9/12  15/12  6/1/12  11//1/12
                                   1st dose                                   12th dose
SGOT                    35*                          49*             63*                  67*
SGPT                    63*                          78*             89*                  90*
HBsAg     366.44  255.68                                                              176.4*
HBV DNA2.54x10^5                                                                   no detect

Result on week# 16

SGOT  86
SGPT  130
HBsAg  10.49

When HBsAg became zero, then what to do? Is that time to stimulate Anti-HBs?
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I just back in my city Jakarta and made a blood check

6 Dec 2012;
AST -34
ALT -53
HBSAG - non reactive
Anti-HBS - reactive 71.43 mIU/mL
I am happy to find AST and ALT now close to normal not like before stay at high level, but my Anti-HBS tend to decline.
With this result, do I need to check HBV-DNA also or any other check should I do? Do I need to worry about Anti-HBS level going down?

Here are my previous lab results,
20/10/11 SGOT-35 SGPT-63;HBVDNA 2.54 10^5; HBSAG 255;
21/10/11 1st dose interferon
11/11/11 4th dose intrfrn
16/11/11 SGOT-49 SGPT-78
9/12/11  8th ds intrfrn
15/12/11 SGOT-63 SGPT-89
6/1/12  12th ds intrfrn
11/1/12 SGOT-67 SGPT-90 ;HBVDNA-undetect; HBSAG176;
3/2/12 16th ds intfrn
6/2/12  SGOT-86 SGPT-130 ; HBSAG-10.49;
10/2/12  17th ds intfrn
22/2/12  SGOT-139 SGPT-210
2/3/12  20th ds inter
7/3/12  SGOT-93 SGPT-161
9/3/12  SGOT-104 SGPT-171
12/3/12  SGOT-94 SGPT-166
30/3/12  24th ds
3/4/12  SGOT-93 SGPT-153
6/4/12 25th ds
10/4/12  SGOT-95 SGPT-143; HBSAG-0.08; HBSAB-negtv;
27/4/12  28th ds
2/5/12  SGOT-96 SGPT-150
6/7/12 38 ds
12/7/12S  GOT-93 SGPT-142; HBSAG- <0.05 iu/ml; HBSAB-negtv
17/7/12 Start taking Baraclude 0.5mg, 1 tablet per day
20/7/12 40th ds intrfn
25/7/12  GOT-108 SGPT-171
15/8/12  Last Baraclude taken
15/8/12  SGOT 117 SGPT 207; HbsAg- not reactive
24/8/12  HBSAB- 70 mIU/mL
14/9/12  48th dose intrfrn
19/9/12  SGOT-102 SGPT-162; HBV DNA- undetct; HBSAG quanty-
<0.05iu/ml; HBSAB- 122.58mIU/mL
16/10/12  SGOT-88 SGPT-165; HBSAB- 107.13 mIU/mL
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This looks like an improvement. I hope you loose weight and eat extremely healthy to counteract fatty liver.
No need to check hbv dna at this time.
A vaccine could be used at this time to see if you can boost the antibody level, this will also help your Tcell response that is doing the major effort to keep you clear.
Avoid any major stress that could impair the precious immune control that you have now established.
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OK, thanks for precious sugestions.
I have to be stronger about food.
And vaccine will be the fisrt thing to do.
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Congrats again Otan.  The ALT is coming down.  Actually vitamin E helps fatty liver..  But I think it takes time for inflammation to settle after killing so many infected cells.  

But i second study for hope suggestion.  

Can i ask where you did your HbSag quantification.  Is it in Jakarta?
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Thanks Jeff912000.
I will try also with vit E.
Yes, i made check for HBSAG quantifcn in Jakarta.
But my last update is for HBSAG positif/negatif, not a quantifcn
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Hi Otan, do you mind posting the cost for 1 shot of Pegasys and Simvastatin? Rough cost is also fine. Congrats on the good result.
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hi m'stef2011 can u explaine it to me wat is the meaning of my result?

Anti-hBs ~ 0.022 CUT OFF 0.105
NONREACTIVE/


HbeAG ~ 0.030 CUT OFF 0.105
NONREACTIVE/


Anti-Hbe ~ 0.028 CUT OFF 0.816 REACTIVE/


Anti-HBc G ~ 0.032 CUT OFF 0.434
REACTIVE/


Anti-HBc M ~ 0.033 CUT OFF 0.105
NONREACTIVE/


*REMARKS* A-HBe, AHBc IgG ABSORBANCE IS =/COV:Non-
REACTIVE. .


I hope u can help me. .thanks a l0t. .g0dblesS. .
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its that a chronic or acute? it can infect other people like my girlfriend? . .
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The cost was IDR 7,500,000,- eqvln USD 780 for 4 doses. Simvastatin is cheap. In Jakarta my city the interferron distributor Roche give the lab check for free in package.
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Dear Studyforhope,
I have finish the 2nd dose of vaccine but no HBS Ab increased.
My GOT/GPT are normal now. Should I take the 3rd dose on June 2013?
With this condition of HBSAb keep decreasing, is it safe from Heps B recurrent?
Thanks for help...

6/7/12 38 dose interferron
12/7/12 SGOT-93 SGPT-142; HBSAG- <0.05 iu/ml; HBSAB-negtv
17/7/12 Start taking Baraclude 0.5mg, 1 tablet per day
20/7/12 40th dose intrfn
25/7/12  GOT-108 SGPT-171
15/8/12  Last Baraclude taken
15/8/12  SGOT 117 SGPT 207; HbsAg- not reactive
24/8/12  HBSAB- 70 mIU/mL
14/9/12  48th dose intrfrn
19/9/12  SGOT-102 SGPT-162; HBV DNA- undetct; HBSAG quanty-
<0.05iu/ml; HBSAB- 122.58mIU/mL
16/10/12  SGOT-88 SGPT-165; HBSAB- 107.13 mIU/mL

6/12/12 SGOT- 34 SGPT-53; HBSAg- non reactive; HBsAb-71.43
10/12/12 Took 1st dose vaccine of Engerix TM-B Adulta dose, r-DNA 1ml HBsAg 20 ug

8/1/13 SGOT-27 SGPT-45; HBSAg-non reactive; HBSAb-52.88
10/1/13 Took 2nd dose of vaccine
22/1/13 HBSAb-43.2
18/2/13 SGOT-25 SGPT-40; HBSAg-non reactive; HBSAb-15.1
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to otan and studyforhope:

waiting for studyforhope response i guess you do need to keep hbsab higher than just around 10miu/ml, maybe keep entecavir or tenofovir for a long time plus repeted dose of vaccine

pisa researchers told me that in case of serocoversion hbsag neg and hbsab detactable they keep antivirals for about 1 year and if needed use hbv vaccine at the same time (even more than 3 doses) until hbsab is good levels

studyforhope knows for sure what to do, maybe use of zadaxin plus tdf or etv and repeted hbv vaccine until hbsab gets high enough
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Zadaxin was indeed shown to clearly improve vaccination response. It can be taken before at the same time or for several  weeks after the vaccination , which seems best. The vaning AB titer is a sign of a lack of a T helper response and could also mean that you could overall loose your Tcell control over the remaining virus, that always lingers in the liver, unfortunately.

I also agree, that adding tenofovir for at least as long until you feel safe with the seroconversion stability is a wise precaution, as Stefano mentioned. I would start for a year and see if the antibody level can be stimulated with the help of zadaxin.

That's about all you can do besides living a very healthy life style and watching your vit d levels.
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Steff and studyfhp
Thanks a lot...
I will find a doctor that can prescribe me this. Sometime is not easy to ask doctor to prescribe what we want.
Thanks again to make me more carefull about my heps, I thought it was OK after I have Antibody.
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Stef,

(zadaxin plus tdf or etv)

What is tdf or etv fullform

And what is the dose of entecavir? 1 per day?
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TDF = Tenofovir, daily dose is is 300mg

ETV = Entevavir, daily does is .5mg
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i d go for tenofovir, more potent, no possibility of resistance at all, cheaper, one pill per day
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Thanks Imran...
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Steff,
I will take tenofovir plus zadaxin.

About vaccine,
2nd dose is a month after the 1st
3rd dose will be 5 months after the 2nd
What about the 4th dose time gap from the 3rd ?
Is there any sides from extra dose of vaccine?

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no, no sides at all i guess, studyforhope might confirm

there are 2 studies on making monthly hbv vaccine in rome and turin, this was few years ago.
after liver transplant many lose hbsag by hbig+nuc, so in those centers they lowered immune suppressive dose and used monthly hbv vaccine to see any hbsab could develop on these patients to stop hbig, i dont remember exact percentage but it was extremely high of patients develpping hbsab in a good titer so they could stop hbig

so in the end i think monthly hbv vaccine plus tenofovir plus zadaxin is a good choice keeping high normal blood values of vit d3 (around 80ng/ml)
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If you can afford it, then the monthly dosing of tne vaccine until your AB TITER is above 200mU is the better way. Don't worry about the standardized timing of vaccine shots. There is no deep immunological reason behind this timing, it is the way the vaccine was approved for prophylactic purposes.
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You should not have any relevant side effects from the vaccine. The zadaxin will be a potent enhancer of the effect on AB levels.
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I am curious to know why Zadaxin is being promoted as a vaccine enhancer? As studyforhope pointed out before, Zadaxin has failed numerous clinical trials as treatment for Hepatitis B and therefore never gained FDA approval as treatment for Hepatitis B, likewise in Europe. It has been FDA approved as an orphan drug for liver cancer. These days, Sciclone makes a lot of money in China only and it is very expensive. I understand Replicor also used it to induce HBsAb production as well as using Interferon. I wonder why?
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Replicors use of Zadaxin in their unique setting of ultralow surface antigen was quite convincing. If you look at the AASLD 2012 poster and the Ab levels after addition of pegasys or Zadaxin, they had more success with Zadaxin and the boosting was truly impressive. Now these are very small numbers and it would be great to see larger trials to confirm that.
But there were several prophylactic vaccine trials were Zadaxin acted as an adjuvant of sorts and again, the results look promising in this application. Another example is the vaccine trial with Zadaxin 3.2mg added from Canada, that Stefano posted in this very same thread to stabilize the surface antigen seroconversion, just about the same application as we have it here in otans case.

Zadaxins principal ability to stimulate the Tcell development is quite established, however the effect is seemingly not strong enough to show in the setting of chronic hepaitis B or C to be of convincing benefit.

Nevertheless, currrently there is no vaccine with an effective adjuvant approved, maybe with the exception of Fendrix in the UK by smithkline, but that is still a mild adjuvant.

The heplisav development of Dynavax where a CpG adjuvant is used to intensify the immune response and that had quite large trials with over 3000 patients to show, with a clear stimulating effect, has, a few month ago been put on a hold by the FDA advisory committee.

Thus at this time the Zadaxin seems to be the only available option to help stimulate the unadjuvanted vaccine towards a Th1 response for someone who want to be proactive against loosing his/her seroconversion status.

Once lost, the vaccine will not work to reverse the loss, thus watch and wait is an uncertain option.

Of course , the general recommendation is to use the advice of a local doctor who is versed in treating hepatitis B. Most however might not be too familiar with the latest or even older research results to recommend, what is to be considered an experimental treatment. Still, nobody should follow any advice obtained on the internet without carefully checking with his liver specialist..

Please also  check the vaccine trial with Zadaxin trial posted earlier in this thread by Stefano.

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Thanks, I need to do some further googling. LOL. The Canadian study was presented as a poster in 2011 involving 8 patients. I read somewhere that a European researcher remarked that up to 1/3 of patients who lost the HBsAg, do not develop HBsAb. Can we assume that the s-antibodies exist but masked by the s-antigen? It is also interesting that in REP9AC', no HBV vaccine was used in conjunction with Zadaxin, just REP9AC'. Is Alum any good as adjuvant with HBV vaccine?
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Steff,
Any problem if I take Baraclude for a month then later I continue withTenofovir. The reason is I have Baraclude 30 tablets I cancelled to take before otherwise I may throw this.
FYI, I took Baraclude July 2012 only a month.
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these antivirals are very slow i dont know if in yuor case it is suitable studyforhope knows kinetics of these antivirals
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Just use the Entecavir that you still have and then switch to tenofovir. It takes about 3days to fully saturate the liver with the active metabolites of these two antivirals, from there on it is a steady state.
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Alum is still a necessary ingredient of the prophylactic HBV vaccine. But it promotes what is called a type II TH2) response, where a cytokines mix is induced that does not propel a cytotoxic TCell response. But rather suppresses it. It is more useful for an organism, that is not yet infected with an intracellular parasite, to limit its reaction to the production of infection preventing antibodies. This also effects the subtype of the antibody within the IGg class that will be produced, from strictly neutralizing to cytotoxic.
If you search joerg reimann and reinhold schirmbeck in pubmed you will find wonderful papers on HBV response induction with various of surface plus core plus RNA and adjuvant approaches and the tremendous variation in response they achieved. All in mice, but no one else has done that kind of highest quality analysis on how a therapeutic vaccine could be composed.

At very low levels of surface antigen, AB tend to become visible even in the presence of the unbound antigen. In this case however, just as in the replicor patients without immunoenhancing therapy, the low visible titer is indeed a low titer.
This phenomenon also shows that the kinetic of immuncomplexing by the ABs is somewhat slow, therefore we have free components present.
This is of great significance, since it points to the need of a very high antibody level if the goal is prevention of local intrahepatic reinfection as it exists after seroconversion or after liver transplant.
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The fact that no vaccine was used in the replicor zadaxin enhanced patients, can be interpreted such that the adjuvant is the critical component, in this case zadaxin, since small amounts of surface antigen is still present in these patients anyway.
This is not to say that a vaccine would not have driven the resulting titer even higher. But it is also possible that he alum contained in these recombinant vaccines would have had a negative effect on the overall outcome.
We must not forget that while the AB titer can be easily measured, the critical effect operating here , invisible to us, might be a reinduction of the all important TCell response. As a matter of fact, we can be quite sure that the boosting in AB titers that was achieved resulted from a T helper response that stimulated the B cells to produce more antibody.
As such we might see the antibody response as a cheap surrogate marker of a more global TCell response that will include the precious cd8+ cells, that have the capacity to clean and clear more remaining infected cells.
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Stef n Studyfh,
Thanks a lot...
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Dear Otan,

How are you recently?  Kindly if you could share your updated status, please.  Many thanks.

Regards,

Cyrus
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Studyforhope, Steff, Cyrus

From 3rd March to 3rd Apr I took Baraclude. Now I have my Viread 4x30 tablets, but not started yet.
Will it good to take Viread while I am in HBV Vaccinasion? Does Viread kill the HBV Vaccin?

FYI, I still cannot find the Zadaxin in Jakarta (indonesia) and Nairobi ( which recenly I visited).

below is my status upodate...



6/7/12 38 dose interferron
12/7/12 SGOT-93 SGPT-142; HBSAG- <0.05 iu/ml; HBSAB-negtv
17/7/12 Start taking Baraclude 0.5mg, 1 tablet per day
20/7/12 40th dose intrfn
25/7/12  GOT-108 SGPT-171
15/8/12  Last Baraclude taken
15/8/12  SGOT 117 SGPT 207; HbsAg- not reactive
24/8/12  HBSAB- 70 mIU/mL
14/9/12  48th dose intrfrn
19/9/12  SGOT-102 SGPT-162; HBV DNA- undetct; HBSAG quanty-
<0.05iu/ml; HBSAB- 122.58mIU/mL
16/10/12  SGOT-88 SGPT-165; HBSAB- 107.13 mIU/mL

6/12/12 SGOT- 34 SGPT-53; HBSAg- non reactive; HBsAb-71.43
10/12/12 Took 1st dose vaccine of Engerix TM-B Adulta dose, r-DNA 1ml HBsAg 20 ug

8/1/13 SGOT-27 SGPT-45; HBSAg-non reactive; HBSAb-52.88
10/1/13 Took 2nd dose of vaccine
22/1/13 HBSAb-43.2
18/2/13 SGOT-25 SGPT-40; HBSAg-non reactive; HBSAb-15.1
----------------------

6/3/13 SGOT-26  SGPT-37; HBV DNA-undtc; HBsAg Qty- <0.05 iu/mL; HBsAb- 26.12; HBeAg- Non React; Anti HBe- React

22/4/13 SGOT-27  SGPT-46; HBsAg- Non React; HBsAb- 20.4
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Here are the countries where zadaxin is approved.


Argentina, Azerbaijan, Bahrain, Brunei, Cambodia, China, Dominican Republic, Hong Kong, India, Indonesia, Kuwait, Kazakhstan, Kyrgyzstan, Laos, Malaysia, Maldives, Malta, Mexico, Moldova, Pakistan, Peru, Philippines, Russia, Singapore, Sri Lanka, Thailand, Ukraine, United Arab Emirates, Uzbekistan, Venezuela, Vietnam
Chronic Hepatitis B
Marketing Approval
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Dear Otan,

How are you recently?  Grateful if you could kindly share your updated status.  Thanks.

Regards,

Cyrus
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Cyrus,
Sorry Cyrus to reply you late, I was at Rig with less facility recently.

My last update,

6/3/13 SGOT-26  SGPT-37; HBV DNA-undtc; HBsAg Qty- <0.05 iu/mL; HBsAb- 26.12; HBeAg- Non React; Anti HBe- React

22/4/13 SGOT-27  SGPT-46; HBsAg- Non React; HBsAb- 20.4

My recent update,

24/5/13  SGOT-27  SGPT-35; HBsAg- Non React; HBsAb- 15.34
12/8/13  SGOT---  SGPT---   ; HBsAg- Non React; HBsAb- 23.32

With me, I feel fit, normal except my finger joint.
I do my work fisically with my hand, lifting load.
Before interferron, if I worked over with my hand (finger) I felt cramp and will recover after a week rest.
But now, the cramp gone after the rest but left the finger joint like stiff.
But it does not effect my work too much.

I am welcome for any questions regarding my theraphy.
Sorry again for reply late.


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did you check ultrasound so that we know the abnormal ast-alt is due to fatty liver and not remaining cccdna in the liver?

do you also have your vitamind25oh to optimum levels?vitd25oh>50ng/ml should help control and resolve fatty liver is present

there is also an hbv vaccine produced in israel since few years, it has all hbsag types (and much more potent than normal hbv vaccine which has only one type of hbsag).we open a thread about it, this is also distributed in some asian countries i believe
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Steff,
Yes, I did ultrasound at Gleaneagles- Penang Malaysia on 3rd Apr 2012 and were AST-93  ALT-153, HBV DNA-und, HBSAg-6.9 index (reactive), HBSAb-1.3 mIU/ml
Ultrasound result;
The liver is normal in size and diffusely increases in echogenicity. No focal liver lesion. No dilated intrahepatic duct/CBD.
The gallbladder appear normal. No gallstone.
The head of pancreas, spleen, and both kidney are normal. RK=10.9 cm; LK=11.1cm in bipolar length. No hydronephrosis. No renal calculi. No ascites. Normal abdominal aorta.

Impression:
Fatty Liver

For vitd25oh, I did not check. I checked the cost was expensive

For HBSAG type, I dont  know what my type is
I may try other type of vaccine.
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i dont think the issue is hbv but you know nobody can tell for sure...i d work on vit d first, if you are not exposed to sun all day and equatorial country your levels should be low and you can start increasing them by long hours sun exposure or supplements with combined vit k2.
dose must be at least 5000iu daily and vit k2 100 or 400mcg daily.high dose k2 can also be found on fermented vegetables or some european cheese

i d check vitd25oh levels only after 5-6 months supplements, it is strange the test is expensive here in europe cost is from 16 to 30€

before taking the vaccine it is best to increase d levels to 80-90ng/ml and then see hbsab levels and ast-alt.i dont know if you seen latest study:
vitamin d correlates to hbvdna and highest d levels are found in low/und hbvdna

normal vit d levels are found on hbv carriers clearing hbsag off therapy
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Steff,
I think I expose to sun a lot.
I live in thropic city Jakarta, secondly I dont work in office but field. Often I work under the sun from 7 - 12 and 13 - 17 daily.

Once I asked for vitd25oh check as you suggested but, it cost like around 200 usd. So Did not check.
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http://www.vitamindwiki.com/Low+cost+vitamin+D+Blood+Tests

http://www.vitamindwiki.com/Quick,+free,+self+test+of+vitamin+D+deficiency

http://www.vitamindwiki.com/Instant+vitamin+D+test+now+available+for+doctors+to+test+at+very+low+cost+%E2%80%93+March+2013

what bastards, 200usd is impossible....check the links for the only extremely cheap vitamin d tests, it worths check even if you are under the sun for so ling time, if there is a phatogen or a bad vdr receptor vitamin d could be low even in your situation
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My last update,

24/5/13  SGOT-27  SGPT-35; HBsAg- Non React; HBsAb- 15.34
12/8/13  SGOT---  SGPT---   ; HBsAg- Non React; HBsAb- 23.32

My recent update
6/11/13 HBsAg- negative; HBsAb- 21.46
8/11/13 Vaccine with Euvax B (20 Ug/lm)
29/1/14 HBsAg- Negative; HBsAb- 26.30
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very good hbsab looks like stable around 20 now, hbv is over for sure

to be superhealthy i think you just have to work on fatty liver since normal alt for women is less than 19
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Thanks Steff for confirmation HBV IS over.
Iam a father of  a14 year old boy.

I try that to avoid the oily food.
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Congrets oten
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Good news...
I checked my HbsAb on 14 Apr 2014 was 112 miU/mL. Increase from before that stable around 20.

And this result I got from my Medical Clearance for my new job in Iraq to the same company I lost my job before in Saudi because of Heps B.
Thanks God...Hope more HBVers get cured.
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very happy to know both your working life and your health have had such improvement.
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Are you taking nucs after hbsag loss as per Studyforhope and Steff suggestions?
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i believe he/she stopped entecavir long time by now, i am not sure but i remember she reported using hbv vaccine to boost hbsab and stopping entecavir...but not sure, have not time to check all threads and just using my foggy memory
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Hi how much is ingerferon? Have you tried using it?
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16584782 tn?1449398004
great info
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