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Anti-HBV virus treatment--need suggestion!!
Hi, guys.
I ( from Asian) have been diagnosed chronic hepatitis B for more than 15 years.  HBsAg is positive. Anti-HBs is negative, HBeAg is positive.Anti-HBe is negative. Anti-HBc is positive too. HBV-DNA has been in 10^7 to 10^8 over the years. My ALT typically is around 20-40. I have been in the immune tolerant state till 2008.  But, in recent 2-3 years, my enzyme level starts to increase. I have done routine Ultrasound examination yearly, but everything is normal. Two years ago, I have done a MRI scan to screen HCC. Everything was normal. My latest test results (this month) show ALT 298, AST 138, very high HBV DNA at 9.8*10^8.
Also, I have high AFP (116), which is quite scaring. I will do a MRI scan soon.

I have discussed with my doctor to start the anti-virus treatment immediately to reduce my liver damage. Since I have been treated with Lamivudine in 2000 for 11 months, which was totally not effective (HBV-DNA did not decrease). But, at that time, my ALT was 40. I should not given this drug considering my immune tolerant state! However, I probably can not blame my doctor too much if it dates back ten years ago. But, this failed treatment may induce LAM-resistance in my body. So, I have to take
either tenofovir or Truvada (Tenofovir 300mg/Emtricitabine 200mg). I prefer to take Truvada at the first begining, then switch to Tenofovir after HBV-DNA is undetectable.

Also, I have big concern about my AFP. I am wondering if it is because of liver cell renaissance after damage. Or it is related to HCC?
Thank you so much for you input.
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Avatar universal
HBeAg is positive.Anti-HBe is negative.

this is very good chances of virus eradication are high

results (this month) show ALT 298, AST 138,
immune activation, right time to treat with immune modulators before immune escape by hbeag negative mutants

Also, I have high AFP (116), which is quite scaring.
quite high but this is due to liver damage and inflammation too not only HCC

Since I have been treated with Lamivudine in 2000 for 11 months, which was totally not effective (HBV-DNA did not decrease).
if you made the mutants you will be at high HCC risk despite hbvdna undetactable.

much if it dates back ten years ago
unfortunately only researchers knew about lam setup

either tenofovir or Truvada (Tenofovir 300mg/Emtricitabine 200mg). I prefer to take Truvada at the first begining, then switch to Tenofovir after HBV-DNA is undetectable.

there are clinical reports of hbv+hdv superinfection cleared by truvada-interferon combo, i strongly suggest this combo with additional alinia started mono 4 weeks before interferon+truvada.truvada alone is useless to eradicate the virus and a long therapy with both tenofovir alone or truvada alone will have many sides if used decades

also follow community closely about gcmaf updates
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Thank you so much for your expert opinion.
I will keep updates of my treatment and follow the updates about alinia an gcmaf in the community.
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