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?

[stef2011]

wow, i'll link your history to pisa researchers hbsag clearance before 24 weeks is rare, even if you start from very low hbsag the lowering is slow

even if hbsag becomes zero you must keep doing interferon absolutely because hbvdna and hbsag are in the serum while inside the liver it will take little longer to have them to zero

i suggest keep doing interferon until:
hbsag und
hbvdna und
alt less than 19

and check monthly for hbsab titer and wait until it is high, at least higher than 200miu/ml
if there is no hbsab development then you need to make hbv vaccine monthly and wait for response

what is hbsab now?did you check it?it may be already detactable

do look for vit d3 too

[stef2011]

by the way hbsag 10iu/ml is 100% clearance

it was already because hbvdna undetactable by 24 weeks of nterferon is clearance for sure by 5 years, i do think simvastatin boosted interferon response very much but of course other should try this to confirm

once hbsag is cleared, nd i think it will take less than 24 weeks, we can open a new thread with interferon+simvastatin experience for you and for others to follow, i will try this for sure too

[Otan]

"what is hbsab now?did you check it?it may be already detactable

do look for vit d3 too ."

No, I did not check it. I am in remote place now, will check it in town soon.
I will try to find this.

[stef2011]

hbsab is anti-hbs, they become detactable in some when hbsag gets less than 100iu/ml

[Otan]

on 13 Feb 2012 I made a check for
anti-Hbs-- negative
HBsAg-- 0.02 iu/mL

Should I wait for sometime to HBsAb to develope or do vaccination?

[stef2011]

yes wait and keep interferon and simvastatin until hbsab>200miu/ml

recheck hbsab at 24 weeks

please repost hbsag and alt results according to week of treatment.which week is hbsag 0.02iu/ml?

results of your interferon+simvastatin are increadible, hbsag clearance by 24 weeks is so rare, we always talk about years for hbsag clearance not weeks

[stef2011]

when you reach 24 weeks of treatment we will check all studies with use of vaccine to boost hbsab, also remember to get vitd3, anyway i am sure you will develop hbsab soon

[Bob0620]

1. If Otan develops HBsAB, does it mean he is cured ?

2. If HBsAg is low, does vaccination effective to increase HBsAB ?

3. Is Simvastatin approved for HBV ? I've read they are still under trial.

[stef2011]

1. If Otan develops HBsAB, does it mean he is cured ?

he is cured even with no hbsab because most patients don t get hbsag or hbvdna back again bt it is easy to get hbsab by vaccine so it is better to try it at 24-48weeks of interferon therapy

2. If HBsAg is low, does vaccination effective to increase HBsAB ?

no hbsag must be 0iu/ml or less than 1iu/ml

3. Is Simvastatin approved for HBV ? I've read they are still under trial.

no it is not approved and it will never get approved because it is too cheap and off patent now but simvastatin is now proved to prevent liver cancer and fibrosis so all hbvers are suggested to use it with ast/alt monitoring

do not wait for an approval or a trial noone will pay for it because there is no payback sim is too cheap.the trial is blocked since 2009 i think and it will neer start

[lema2210]

May I ask what status you were in before treatment? Were you on antivirals before, your hbseg status, etc? Thanks.

[grmr]

i join lema2210 question.. pls inform about your status prior to tx.

were you hbv carrier since birth?
liver status?
eag status?
age?

are you experiencing side effects on iterferon?

[stef2011]

it can also be important if there was use of anticholesterol drugs/statins before interferon and how long

gmr:
she has reported mild sides in another post but i d not consider them sides because those are signs of immune activation

[grmr]

so what mild sides?

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/HBV-almost-cleared-12-weeks-with-interferonsimvastatin/show/1676186

[Otan]

Sorry to reply late, I was at remote location internet access limited.

May I ask what status you were in before treatment? Were you on antivirals before, your hbseg status, etc? Thanks.
Before interferron treatment I did nothing at all since I felt healthy. I do the treatment becoz I lost my overseas job.

Before treatment
SGOT                    35*    
SGPT                    63*  
HBsAg                255.68  
HBV DNA         2.54x10^5    
HBeAg             non reactive
Anti HBe           reactive

Byopsi result
Chronic Heps B Metavir grade-1, stage 1.

[Otan]

i join lema2210 question.. pls inform about your status prior to tx.
pls see, i ve answer lema2210

were you hbv carrier since birth?
more probably, I have my brother has HBV. Mother never check but healthy now 78 years.

I am 47 now.


are you experiencing side effects on iterferon?

Below is my experience with Interferron teraphy,
At 1st injection, Doctor asked me to stay at hospital for 24 hrs to see the effect, but everything felt normal. Same thing happen with 2nd injection.
After 3rd injection, started feel flu symptons , dry mouth (thirsty), less taste for food (my portion still normal) but still feel strong
After 4th injection, feel headache, sleepy/weak, less taste for food  and itching. But I still can riding bicycle for exercise.
After 10th injection, sometime light headache, dry mouth,  itching , less taste for food  but feel little stronger.
But now itching is less.

[Otan]

it can also be important if there was use of anticholesterol drugs/statins before interferon and how long

No , interferron come together with simvastatin

[stef2011]

you ll sure get your job back now, hbsag is already negative at 0....iu/ml, we just have to wait for hbsab to rise

[stef2011]

i think this may easily apply also to hbv vaccine, vitd25oh>50ng/ml in serum are also needed for peginterferon therapy optimal response

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016709

BCG Vaccination: A Role for Vitamin D?

Conclusions
Vitamin D may play an immuno-regulatory role following BCG vaccination. The increased vitamin D concentrations in BCG vaccinated infants could have important implications: vitamin D may play a role in immunity induced by BCG vaccination and may contribute to non-specific effects observed following BCG vaccination.

[stef2011]

i found article about hbv vaccine to make hbsab in those with no hbsab, i will pm email of researcher so if this happens to you after 48weeks of interferon you can contact with him

INDUCTION OF HBS ANTIBODY PRODUCTION AFTER
ELIMINATION OF HBS ANTIGEN IN PATIENTS TREATED
WITH NUCLEOSIDE(TIDE) ANALOGS AND AUGMENTED
IMMUNO-ENHANCEMENT THERAPY AS A PRELUDE TO CURE
University of British Columbia, Vancouver, BC, Canada

Background: Curremt treatment of Chronic hepatitis B aims
at clearance of circulating viral load reducing HBV DNA to
undetectable level. This is followed by more recent advances in
eliminating HBs antigen which is a reflection of the amount
of intracellular cccDNA. Elimination of HBS antigen is regarded
as an ideal end point of Hepatitis B treatment. However, HBS
antigen loss does not imply total eradication of cccDNA which
can still act as a template for viral replication. Only when
protective levels of HBS antibodies are produced in such patients
can we then safely declare them as under permanent hepatitis B
control.
Aim: To demonstrate the induction of Hepatitis B antibodies
production in Chronic hepatitis B patient cleared of HBS antigen
with Nuclotide(side) analog with or without immuno-enhancement
therapy with augmented doses of Recombinant HBV vaccine
together with immuno-vaccine enhancer.
Method: 8 patients: 7 male and 1 female, age 29–53, median age
38 who were successfully treated with entacavir or tenofovir with
or without interferon or thymosin achieved negative serological
detection of HBS antigen, They were given augmented doses of
Triple Recombinant Hepatitis B vaccine (Engerix B) IM toghether
with immuno-vaccine enhancer Thymalfasin 3.2 mg SC. on Day 0,
Day 30, and Day 180. Hepatitis B surface antibody were then
measured on each patient on Day 210.
Results: 6 of the 8 patients demonstrated positive response with
protective tires of HBS antibodies ranging from 50–600–mIU/ml.
One patient showed no response and one patient’s results are
pending.
Conclusion: Induction of antibody against HBS antigen is achievable
in patients with Chronic hepatitis B after HBS antigen elimination.
This is definitely a prelude to the permanent control of Chronic
hepatitis and probably a cure for this incurable disease of the
past

[Otan]

Hbv DNA become undetected, HBsAg - down to 0.02.
HBsAb - negative.
But why SGOT / SGPT still increasing? What does it tell? Is it normal?


6 feb 12
ast- 86
alt- 130
hbsag- 10.49

13 feb 12
hbsag- 0.02

22 feb 12
ast- 139
alt- 210
hbsab-- neg

[stef2011]

But why SGOT / SGPT still increasing? What does it tell? Is it normal?

absolutely normal and the higher the better, it means your immune system is killing infected cells and that s why hbsag and hbvdna have gone down because all infected cells producing hbsag and hbvdna are being killed

when ast/alt gets normal it means most of the infected cells are killed and hbsab will rise.hbsag and hbvdna tests in the serum are very poor sensibility so even if we see hbsag und and hbvdna und in serum they are still present in the liver.
the best situation with interferon is a alt rise to 1000-1500 like in acute hbv in this case hbsab is very fast like for acute hbv, with alt at 100-300 it may take longer

the slowest is seroconversion with normal ast/alt, this one takes years like 5-10 years usually, this is the worst situation both on interferon and antivirals.of course hbvdna must be und in serum otherwise it means rise of alt is due to virus winning over immune system and not the opposite

[stef2011]

also do not worry about alt levels they are not correlated with liver damage unless this alt rise goes on for 6months or longer

[stef2011]

alt flares over 1000 are dangerous only for cirrhosis patients, while less than 1000 are not dangerous even in case of cirrhosis if compensated

[Otan]

Thanks for info that stop my worry...

[foxs]

i am 32 year old  my sgot is 100 and sgpt is 200 and my HBsag is non reactive my question is this iam infected by HBV or not

[foxs]

i am 32 year old  my sgot is 100 and sgpt is 200 and my HBsag is non reactive my question is this iam infected by HBV or not

[foxs]

pls help me because im verry worried now i cant sleep well

[stef2011]

probably another hepatitis virus, check hbvdna and hbsab

[liervo]

on my situation as a chronic hepatitis b carrier for 11 years, do you think i have a chances to become zero my result of hbsag=435.20 sgpt=47,sgot 32, in this case..interferon are aplicable for me?

[stef2011]

hbsag=435.20

what is the machine used?what is the unit oof this result?

that number looks like the ultra obsolete and useless ELISA method, please check and repost hbsag value by abbott architect machine

[liervo]

thanks stef for the advise but unfortunately..that was the result..may they got a mistake..thats why after my contract here in abroad..i try to look better laboratory to examine the correct hepa profile test..in philippine do you know where can i find it? thank u stef2011 for being a supportive to all hepa b carrier..god bless

[Jeff912000]

Simvastatin potentiates the anti-hepatitis B virus activity of FDA-approved nucleoside analogue inhibitors in vitro.
Bader T, Korba B.
Source
Section of Gastroenterology, Department of Medicine, University of Oklahoma Health Sciences Center, VA Medical Center, Mailstop 111H, 921 NE 13th Street, Oklahoma City, OK 73104, USA. ***@****
Abstract
Statins are 3-hydroxyl-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors used for the treatment of hypercholesterolemia. We report that a particular statin, simvastatin (SIM), exhibits strong in vitro anti-HBV activity. Moreover, a combination of SIM with each of the individual nucleos(t)ide analogues lamivudine (LMV), adefovir (ADV), tenofovir (TEN) and entecavir (ETV), showed synergistic antiviral activity. Combination drug treatments were performed in the HepG2.2.15 cell line. Compound combinations were centered on a mixture designed to deliver approximately equipotent (not necessarily equimolar) concentrations of each agent, based on the ninety percent viral inhibition monotherapy values. SIM interacted favorably with all four licensed anti-HBV nucleos(t)ide analogues, especially at molar ratios that approximate combinations likely to be used clinically. As the relative concentration of SIM was raised to an excess, the overall favorability of the interactions progressively increased. SIM displayed about equal degrees of synergy with ADV and TDF. The highest degree of synergy was observed at the 300:1 combination of SIM with ETV. Interactions with LMV were the least favorable. The in vitro potential shown here may greatly augment anti-HBV therapy clinically.

[April9903]

Do you think it's a good idea to add Simvastatin to my existing tx of Peg+TDF+NTZ+Vitd3 ?

[stef2011]

not now since you are already responding

[4est]

I don't know if is OK or not to add Simvastatin, but you should consider first your cholesterol levels

[veteranB]

Wow.. That is awesome..

Simvastatin, maybe I should try that too..

[April9903]

ok....Just checking.
Last time I check my cholesterol levels, it was very good. I don't remember the exact numbers but it's in the desirable level; low LDL and high HDL.
May be I'll check again this month.

[stef2011]

the levels suggested to weken hbv from a study were about:
tot chol less than 150
ldl less than 70
hdl>60

but it is not the blood chol level to matter but the intracellular level which is different, interferon works in many ways one of these ways consists in lowering intracellular cholesterol so that hbv has no material to build its own antigens (hbsag in particular which is made of cholesterol for the most part)

hdl has been found to be antiviral at high levels but there was no correlation between blood levels and intf response while tot chol and ldl influenced intf response when lower or equal to the levels above

[Otan]

Steff,
Sorry not to write anything for so long.
I thank Jesus for yesterday I check HbsAb is 70. (reactive).
Last check for this was 12 Jul 12 still negative.

Here are the 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

Since I was away from my doctor, my wife saw my doctor with my 15/8/12 lab result. Doctor prescribe me with another month of Baraclude and HP pro (may be same Legalon by Madaus) and Estazor (Ursodeoxycholic Acid 250mg)

24/8/12  HbsAb- reactive ( 70 ).

I still have 4 more dose interferon to go.
My doctor does not know yet HbsAb devolved.
But I don,t want to take Baraclude anymore since it make more headache and also I have HbsAb already.
Is this good decision to stop Baraclude?

Rgds
Otan.

[stef2011]

why take baraclude?it lowers immune response and it makes no sense to take it with hbvdna und and hbsag und and hbsab detactable, i really dont see the point

is it a normal doctor or a researcher?

go with intf, vit d3 and simvastatin, not baraclude which suppresses immune function
you may also use hbv vaccine to boost hbsag faster

[stef2011]

can you please reoport how you used simvastatin and doses?even if you started with low hbsag the response was superfast, patients starting from as low as 16iu/ml hbsag had less response than you in such a short time

please also confrfirm time to hbsag negative and if you used hbv vaccine

[stef2011]

sorry abd also vitamin d3 you took and serum levels if available.you are a very good case and it will be interesting to see if others can get such a fast response i myself will try adding sim to imiquimod and intf

[Otan]

I remember when my doctor stop sinvastatin and then you suggest me to continue even with more dose to 40 mg. And also you suggest to take fit D3 5000 mg. I took your suggestion 40 mg sim and 1000 mg Vit D3 but then I feel more the effect like headache. then I decide my self to stop it and only taking interferon.
Then also, I tried to see 3 doctors in my city to ask them to do vaccination but no one agree.
Then I never see Doctor again after dose#20. I only bought interferon and I do it my self since I saw it good progress. Doctors only give me more drug to take.
I see another Doctor again after Dose#39 and He prescribe me with the Baraclude which I stop it now by your suggestion and even more pain/weak after taking it.

HbsAg quanty was 0.08 iu/ml on 10 Apr 12 and was <0.05 iu/ml on 12 July 12.( may be already non reactive but I did not check)
HbsAg not reactive when check it on 15 Aug 12.

On 24 Aug 12, I made a check for HbsAb and I got 70 mlU/ml. I was so happy to know this.
HbsAb was still negative on 12 Jul 12.

Vaccine, I do not do vaccine yet.

Serum vit D3 25 OH, once I ask this to clinic but again it is expensive then I cancel to check it.

I think I am lucky with the teraphy and I hope you all be lucky too...

[imdb90]

Congratulations for the victory.The news you have bring to this forum is very rare. Bravo.

[stef2011]

get close monitoring on hbsab fro about 6 months, possibly every month and if you see a decline in hbsab restart baraclude, after 6months of hbsag neg, hbsb>10miu/ml and hbvdna und victory is definitive

[Otan]

Steff,
Ok thanks for this info...

[stef2011]

sorry to bother again i am trying to understand if there is any simvastatin effect on your fast result.
was the biggest decrease on hbsg during intf+sim+vit d3?

[stef2011]

http://medicina.udea.edu.co/gastrohepatologia/articulos/2010-II/Estatinas-%20Colesterol%20y%20RVS%20en%20HCV%20Hepatology%202010.pdf

some data from hcv intf+rbv+statin

[Jeff912000]

Sounds like only low dose 10mg Sim is needed for Otan.

I saw this study where inf is increased at low conc of Sim but abolished at high concentration.

Statin-Induced Proinflammatory Response in Mitogen-Activated Peripheral Blood Mononuclear Cells through the Activation of Caspase-1 and IL-18 Secretion in Monocytes1.

http://www.jimmunol.org/content/176/9/5284.short.

Congratulations Otan.  Also thanks for sharing.  We could all learn from your success.  

[veteranB]

Congratulations. Maybe your doctor can just accept us all as his patients.

[stef2011]

wht do you think of the combo intf+sim and doses?the study on nucs+sim indicated 40mg or little higher sim as the minimum dose with effect

but this study suggests lower doses, i guess we cannot apply this study to hbv
http://www.jimmunol.org/content/176/9/5284.short

[veteranB]

I sure would love to find out by trying.

[Otan]

1st dose to 12th dose, with 10mg simvastatin, HbsAg decreased from 255 to 176.
12th dose to 16th dose, with no simvastatin, HbsAg decreased from 176 to 10
16th dose to 18th dose, with 20mg sinvastatin, HbsAg decreased from 10 to ?? (not check)
18th dose to 25th dose, with no simvastatin, HbsAg was 0.08

[buthatha21]

how much is that interferon? also simbastatin?

[buthatha21]

is there any problem about eating foods?? hep b reactive. can i still eat different kind of foods?? as long as i never drink alcohol and never smoke??

[stef2011]

good to know i ll follow ur schedule because 40mg makes me sides

[Jeff912000]

I though Stef's idea of using HBV vaccine is good.  To get antihbs as high as possible

[Otan]

I will try this once I back to town
Thanks Jeff.

[Otan]

peginterferon alfa 2A, 180 microgram/ 0.5 ml
simvastatin 10 ml

[Otan]

During interferon theraphy I totally change my food.
As much as I can I avoid fried food, oily, fat, sugar.
Most of the food was steamed and fruit. Also I took more water.
Sour fish soup is more when I am home.
Everything I will take, first question is "is it good to my liver?"

[Jeff912000]

Hi Otan.  

Sorry i need to ask a personal question.  I often wondered how sex affects immunity.  They say more than 3 times a week is too much.  Or Did you abstain from sex during the whole treatment?.  

[veteranB]

make sure she is vaccinated and fire away. But when you are on peg you have to watch out how fast you run ;)

It is like when you have a flue or you are sick sex is the last thing your body will want. So as they say go with the flow.

[Otan]

I dont know if sex effect immunity.
I did it less because I felt not very fit. I can say frequency down to 50%

[Otan]

on week# 40, 24 Aug 12
HBsAb: 70 mlU/mL
on week#48, 19 Sep 12
HBsAb: 122.58
SGOT: 102
SGPT: 162

on 16 Oct 12
HBsAb: 107.13
SGOT: 88
SGPT: 165

Is this normal my HBsAb level down from 122 to 107 in a month after therapy?
At this stage, (HbsAg- not reactive; HBV DNA- undetected; HBsAb- reactive) Is HBV not present in my system at all or is HBV possible recurrent?

rgds
otan

[stef2011]

it is possible recurrent because you are still fighting cccdna inside liver cells, and it is also possible for hbv to mutate hbsag and escape your immune response but this mutation is rare

i just asked this to researchers yesterday, what if after intf hbsag gets und but hbsab not detactable......they said before stopping intf at 48 weeks we use antivirals for 6-12 months and see if immune system is able to keep both hbsag and hbvdna und

the bad thing is the high alt for so long despite hbsag, hbvdna und.it looks like virus is still there fighting inside the liver and trying to escape your immune response.

i d go for tenofovir add on and see how hbsag, hbsab, hbvdna, ast/alt change.if ast/alt goes normal and hbsab rises i d stop intf and keep tenofovir for 6-12 months and then see if your immune response has clear hbv complitely also inside the liver
i dont know if keeping intf for more than 48weeks can make sense instead of tenofovir.with tenofovir hbv has little space for trying to mutate and will be attacked by your immune system fully

post the question to studyforhope, he i superexpert on this

[veteranB]

You don't think that maybe his body is still in the process of clearing HBV from the liver cells?

As for antibody levels to fluctuate I think it is normal. So long as HbsAg- not reactive; HBV DNA- undetected; HBsAb- reactive I would not worry.

What I would do is try to use Heptech or some other hepato protector like MilkThistle to help the liver. I think Otan body is clearing still clearing HBV from the liver. So I would not worry..

[stef2011]

sorry what you posted make no scientific sense nor the tests or the heptech suggestion.

heptech must not be used with interferon because it is antinflammatory and inflammation is a part of immune response needed to clear, she is in the point of clearing and can t use wrong products now

otan please follow what i posted and consult with an experct doctor about the way to sustain the immune response that you reached and avoid imune escape from hbv
alt at 165 for such long time means a lot of virus is still in the liver, again tenofovir is what is used here for 6-12months at least one month before the finish of intf therapy

[veteranB]

If she has HbsAg- not reactive; HBV DNA- undetected; HBsAb- reactive - that means cured... just let the immune system do the job.

if they say it is not advisable to use hepatoprotectors  with interferon's then sure lets not use them.

My thinking was while the immune system sees the virus and clears it, heptech or milk thistle can help reduce the inflammation along the way with immune system clearing the virus.

If you think HepB is mounting an attack and hepatoprotectors will interfere with immune system clearing the virus then sure antiviral will stop it and that is also a way to do it. But I think you have also said before that antivirals suppress our immune system as well.

So that is why there is no right  approach to this. I would just wait and see and increase all the nutrients and drink more water and let the body do the job.. The SGOT: value is declining, maybe in a month or so ALT will start to go down..

[veteranB]

all this just shows how nasty this HBV virus really is if even after seroconversion this happens with some people.

[Otan]

steff,

thanks for the info make me more focus to watch my heps

[Otan]

veteranB,
thanks for opinion , hope it no recurrent

[studyforhope]

You report only AB levels lately. Is the surface antigen still negative?

Also it would be important to check the dna levels again. Your high alt is ominous.

You could have switched to occult hbv status.

You could have developed autoimmune hepatitis fostered by the ifn therapy.
It would be ulseful to check ggt levels also.

You could have developed autoimmune myositis, which can also raise ast and alt levels with no liver involvement. CPK levels would clarify this.

[Otan]

studyforhope;
I checked last month 19 sep 12, after week#48; HBsAg- <0.05iu/mL and HBV DNA- und. Do you think good to check it monthly?


on week# 40, 24 Aug 12
HBsAb: 70 mlU/mL

on week#48, 19 Sep 12
HBsAb: 122.58
HBV DNA: und
HBsAg: <0.05 iu/mL
SGOT: 102
SGPT: 162

on 16 Oct 12
HBsAb: 107.13
SGOT: 88
SGPT: 165

rgds
otan

[studyforhope]

These findings argue against hbv as the souce of the ongoing liver disease.

The dominance of alt vs ast almost rules out myositis. Thus we have to look for other sources of ongoing liver damage.

Autoimmune, possibly triggered by ifn. This is hard to diagnose.  Autoantibody panels are the first step.

Nonalcoholic fatty liver disease. Are you overweight?

I assume you consume no alcohol or other liver toxic meds.

Biliary liver disease. More rare, GGT is a first step

[Otan]

yes , I am over 7 kgs
Drink no alcohol at all and no cigarette. I think my food is good since I selective to this.

[stef2011]

you may try bitter melon, high dose omega 3 fish oil and vit d3 which are always good in the diet to see if it can be due to fatty liver or metabolic symdrom and keep checking for autoimmune hepatitis in the meantime.

did US show any fatty liver in the past?

is it possible that you have spread of other viruses in your asia area like hepatitis E or others?

[veteranB]

you are right it is good idea to Check for Hep E and TT, but I think those would get killed with interferon fast.. usually 2 months intf treatment for TT.. and they usually don't check for it.

In the US they don't check for Hep TT. You know why? Because there is not treatment for it! :) аs shocking as it is but that is how they say it. Absolutely nuts.

I just think that Otan body is still clearing the virus. I would wait a month or so and monitor it..

But if they can't find another bug by blood maybe a liver biopsy can tell what it is..

Another  none invasive way to look for infections spots if by blood is all clear is to do a WBC indium scan of the whole body.. It will find hot spots. And then do a PET scan on the are that lights up. That is how they look for cancer cells, but it is a good tool for infections too.

[Otan]

On 3rd April 2012 I did US and result , impression : "Fatty Liver"
So far only check heps B and C. Never check heps E.

[stef2011]

if it says fatty liver we found the reason, fatty liver can be worst than hbv on liver damage....

see here how i clreaed it in few months:
http://www.medhelp.org/posts/Hepatitis-B/update-on-my-fatty-liver/show/1500346

you have to take diet, vitamins/antioxidants/herbs distribution during the day and doses like religion

excercise help they say but i have to tell you that i always had some excercise and trdmill but never lost a pound so i think they key is those vitamins and that food especially black rice.

[veteranB]

You don't think fatty liver is do to HBV or NUCS use?

[Jeff912000]

Some studies follow up for one year to allow ALT normalisation.  It wouldn't hurt to test GGT and alkaline phosphatase and autoimmune panel like studyforhope saids.  

[Jeff912000]

I do not think it is occult HBV because even occult HBV have some detectable HBV DNA.  

[Jeff912000]

1334941

[Jeff912000]

There is a lot of debate whether occult HBV occurs in individuals with antihbS.  By logic this is all protective antibody.

[Otan]

Studyforhope,
At the moment I am in Perth Austrlia which is expensive for me to see doctor and lab.
Once I am back  in Jakarta I will do checkings.

[stef2011]

you may simply lose weight and see how alt changes, at bmi 21 you just get better health and improve liver function very much

as regards supplements easily available everywhere you may also try to increase hdl to higher than 60-80 by high dose omega 3, vit d3 and glutathione by injections or liposomal.

i d consider occult hbv only after excluding fatty liver, in any case occult hbv is of little importance as long as ast/alt normal, hbvdna very low and no hbsag mutants that increase hcc risk

[Otan]

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

[studyforhope]

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.

[Otan]

OK, thanks for precious sugestions.
I have to be stronger about food.
And vaccine will be the fisrt thing to do.

[Jeff912000]

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?

[Otan]

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

[imdrew]

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.

[Ariston]

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. .

[Ariston]

its that a chronic or acute? it can infect other people like my girlfriend? . .

[Otan]

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.

[Otan]

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

[stef2011]

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

[studyforhope]

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.

[Otan]

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.

[Otan]

Stef,

(zadaxin plus tdf or etv)

What is tdf or etv fullform

And what is the dose of entecavir? 1 per day?

[imran4535]

TDF = Tenofovir, daily dose is is 300mg

ETV = Entevavir, daily does is .5mg

[stef2011]

i d go for tenofovir, more potent, no possibility of resistance at all, cheaper, one pill per day

[Otan]

Thanks Imran...

[Otan]

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?

[stef2011]

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)

[studyforhope]

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.

[studyforhope]

You should not have any relevant side effects from the vaccine. The zadaxin will be a potent enhancer of the effect on AB levels.

[StephenCastlecrag]

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?

[studyforhope]

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.

[StephenCastlecrag]

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?

[Otan]

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.

[stef2011]

these antivirals are very slow i dont know if in yuor case it is suitable studyforhope knows kinetics of these antivirals

[studyforhope]

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.

[studyforhope]

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.

[studyforhope]

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.

[Otan]

Stef n Studyfh,
Thanks a lot...

[cyrus131]

Dear Otan,

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

Regards,

Cyrus

[Otan]

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

[studyforhope]

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