Baraclude vs. Viread

Hi All,

I am an male in my mid-20's of southeast Asian decent, and I'm quite torn about how to proceed. I acquired HBV through vertical transmission and am currently in the immune clearance phase.

My ALT levels are 5-6 times normal.
I am e-antigen positive, e-antibody negative.
My viral load was 30 million in Oct 2008. Since then, I've been taking a cocktail of herbs intended to treat hepatitis (including milk thistle) and in Jan 2009, it is now 13 million.

I am torn because my family would like me to stay with herbal cocktail, but several doctors want me to begin treatment. The doctors say the fluctuation in viral load is natural and not necessarily tied to my use of herbs.

Firstly, has anyone had success with the herbal remedies?

Secondly, if I begin treatment, the goal would be sero-conversion (i.e. e-antigen negative, e-antibody positive). Would that essentially mean I'm cured and won't need to worry about HBV anymore?

Thirdly, my doctor says it's pretty much a flip of the coin to decide whether to go with Baraclude(entecavir) or Viread(tenofovir). There seems to be very little data about the success rate of either. Can anyone please help me to decide which route to take? For example, comparison of side-effects, success rate(i guess that means sero-conversion) in asians, etc.

And finally, how much of a difference would it make if I start treatment now or in, say, 6 months?

Being 25, I will potentially be taking this pill for many many years, so I'd like to make the right choice.

I'm new to this forum and would very much appreciate your time.

[zellyf]

Hang on.  I want stevenNYer to see this.  He'll pop in soon with some advice for you.

[cajim]

If antiviral is the route you choose, then your ALT and VL reading match the 2007 guideline recommendation for treatment.  Both Baraclude(entecavir) or Viread(tenofovir) are effective in this line of treatment.  When you choose the latter, you need to keep an eye on your creatine level (kidney damage indicator).

[cajim]

"Firstly, has anyone had success with the herbal remedies?"

I am trying a non antiviral remedy but it will take 2 years to see the result.

[AsianMale]

Thanks for the response. Then why would I choose Viread at all? Why not just go with Baraclude? Is Baraclude supposed to be safer?

[cajim]

Because Baraclude has its own headaches, e.g. the Chinese HBV site often mentions concerns about Baraclude relating to cancer.

[stevenNYer]

Welcome to our forum.  It's nice to see a first time poster having done some research and learning for himself before asking questions.  It just makes it easier and more meaningful when we don't have to explain the basics.

Firstly, I think herbal remedies are okay to use to support liver functioning.  But don't expect it to help you "e" or "S" Seroconvert.  In terms of stats, it's not going to happen.  It also won't limit or stop viral replication.  You labs pretty much proves this point.  

Secondly, even if you successfully "e" Seroconvert in time, you still need to monitor your condition.  Disease "re-activation" is common among "inactive carriers", especially over time.

Thirdly, choosing between Tenofovir (Viread) and Entecavir (Baraclude) is like flipping a coin.  Both have good antiviral power.  Both have minimal side effect.  Both have little things to worry you a little (as pointed out by cajim's post).  Neither have research showing negative effects of long term use for HepB.  So far so good.  If you could only get your hands on one (depending on your insurance coverage and wallet size), either one is fine....But if you could afford both, do both.  Given your high viral load, do all you can to minimize risk for antiviral resistance.  Combo it to x-fold the antiviral power and down the DNA quickly so the virus loses its adaptive power (that is has in large numbers...13 million in your case).  Combo until you "e" Seroconvert or even until you reach UND DNA and go mono with either Tenofovir or Entecavir.  You will buy your med more time this way.  As you say, you may need to take this for a long time.  You need to protect you cross-protect your meds to make sure it works for a long time.

Finally, if you made a good guess by a series of labs that you are in immuno-clearance phase, treat it.  Waiting 6 months won't make much of a difference but why wait.  You ALT shows you your liver cells are taking a hurting.

And welcome to my boat...the "e" Seroconversion could take time...I know...all to well....

Good luck to you.  Stick around and let us know how you are doing.

[AsianMale]

Thank you for your lengthy reply. I tried to go back and read some of your posts since it sounds like you have a good amount of experience with HBV, and I am quite impressed by the thoroughness of your posts. Your dedication to helping the community is really quite touching. How long have you been trying to seroconvert?

Viread offers a 5% chance of loss of HBsAg in 48 weeks while Baraclude offers a 5% chance in 96 weeks. Do you think it's safe to conclude that Viread has a higher chance than Baraclude of wiping out the virus?
Also, since Viread and Baraclude are both meant to lower the viral load, it seems treatment should be combined with Pegasys (which provides roughly a 10% chance of "s" antigen loss) to boost the immune system for maximum efficacy...at least that's what my common sense tells me since Pegasys is most effective when ALT levels are elevated and viral load is low. I mean, isn't that what we all ultimately want? To lose that "s" antigen? Losing the "e" antigen still means lifelong bloodtests...

I feel somewhat uncomfortable taking both Viread and Baraclude. Is there conclusive data showing the safety of taking both simultaneously? Is that what you're currently doing? If so, have you noticed any side effects with either? or both?

Also, does anyone know where the magical Indian herbal cure for hepatitis stands today?

Thanks again for your last post. It's nice to know we're not alone in this seemingly never-ending journey...

[AsianMale]

For Viread:
"...by week 96 of Study 103, 6 percent of all patients continuing treatment in both groups experienced “s” antigen (HBsAg) loss, which contributes to resolution of chronic hepatitis B infection (HBsAg seroconversion rates were 4 percent among patients originally randomized to receive Viread and 5 percent for patients who rolled over from Hepsera)."

For Baraclude:
"treatment with entecavir for up to 96 weeks (n = 354) resulted in...2% for HBsAg seroconversion (5% for HBsAg loss)"


According to these studies, seroconversion of "s" antigen is more likely with viread (4%) than with Baraclude (2%). Either way, the chances are low, but I prefer 4% low to 2% low. :)

Thoughts?

[zellyf]

AM,

My own approach is to not continuously strive for the Holy Grail of an "s" seroconversion which occurs at a rate of 1% a year.  Instead, when the time comes for me to choose a treatment option I will focus on disease management with the best long term results based on currently available data.

[stevenNYer]

I found out that I have chronic HepB by chance in 2005 and treated and waiting to "e" Seroconvert since then.

Forget "s" Seroconversion,  1%, 5%, whatever, I don't expect it to happen.  Disease management is the way to go.

As for the "herbal cure", countries where Hep B is endemic all have magic "cures".  Bottom line is they don't work, otherwise they won't have a HepB problem.  Did this logic lose anyone?  Be warned and spend your money wisely.

It's interesting that you mentioned pegsys.  A good treatment strategy is to use use pegsys to bring down the DNA, then use mono-therapy with either Tenofovir or Entecavir to keep it UND.  This strategy is also to keep the risk of resistance down.  

I didn't consider pegsys for myself because I can't risk the side effects, since I am, as they say in the "prime of my life". Just too much things to do and if I can't do it, it puts too much pressure on my family.  For chronic carriers, the expectation for treatment should be to reach inactive carrier status or stay UND.  Interferons or antivirals?  Antivirals for me.

So listen, naturally I get 1%,  Entecavir gets 2%, Tenofovir gets 5%, since I am combo-ing with these meds, does that mean I have a whooping 8% chance to obtaining the Holy Grail?  Hahaha.  You have to be realistic and have a sense of humor in this.  And I'm fine combo-ing.  I'm still here and kicking (and avoiding those, windows, and I had sex with a pro and I worry about HepB posts).  And No sides.

[AsianMale]

Hi Steven,

If I were to go ahead with the Viread/Baraclude combo therapy you suggested, is there an optimal dosing of each that you would suggest? Do the "experts" agree on how many mg of each?

Thanks!

[cajim]

Not sure, but maybe:

Viread 300mg/daily
Baraclude 0.5mg/daily

[stevenNYer]

For this particular combo, Cajim is right.  Tenofovir 300mg daliy and Entecavir 0.5mg daily.  Tenofovir should be taken with food.  Entecavir should be taken with empty stomach.  They should be taken 12 hours apart from each other.  I take Entecavir first thing when I wake up.  Breakfast 2 hours later.  Tenofovir I take with dinner.  You should find a schedule that works well for you, if your MD decides to go with this combo for your particular case.  Good luck.

[Sharp7]

To those worried about the side-effects of pegasys, this has been my experience using pegasys since Apr 2008:
My baseline WBC count was 6000+. It has gone as low as 2800, but usually hovers between 3500 and 4500. My Neutrophil count has never fallen to an extent that would require me to alter the dosage or stop the meds.
My baseline platelet count was 200,000+. Though in the normal range now, has at times touched 110,000. Again, not low enough to alter the dosage.
I've heard that many people get fever every time they administer peginterferon. I ran a fever of 102F on the first day that I was injected. Never again.
What else? Weight loss: baseline 67Kg. Now 58Kg. I see no reason I should be worried.
Baseline height 177cm. Still the same ;-)
Anything else? Hair-loss! I've lost a little bit, I suppose. I don't know how much, and I don't care.

The reason I post all this: if some of you are worried about starting peginterferon, and the only factor holding you back is all the scary things you've heard about it, well, here's some anecdotal evidence. It's been OK for me so far. YMMV. I was worried about the side-effects of peginterferon too. Before I started, I even used to think I might even get suicidal when I'm on this. One more thing: my meds supplier tells me that younger people tolerate this fairly well.

The good news so far: baseline HBV DNA level ~4,000,000 copies/ml. Currently below measurable range (<6000 copies/ml by PCR at this lab). But still HBsAg+, HBeAg+.
Baseline ALT: 152. Now 21.

PS: My intention was not to recommend FOR or AGAINST peginterferon or anything else. Just sharing my experience.

I'll probably start entecavir soon after I complete this.

[hepbinme]

Hey guys, I'm new to the forum -- I just found the thread through Google by searching Viread + Baraclude. My apologies if I ask a few stupid questions, I'm still learning a lot about HepB. =]

I want to start off by saying that I have been taking both Baraclude + Viread as part of a study. I will try to be specific as possible, but all my paperwork and results are back at home since I'm away for college. I'm 23 years old and found out I had chronic HepB. My first blood results were (taken in 07/18/2008):

HEPATITIS B VIRAL DNA, QUANT PCR            1630000000 H    <160 copies/mL

HEP B VIRAL DNA QT                                      341000000 H     <100 IU/mL

Can anyone help me with reading those numbers? I know they're in some type of units, both meaning the same count...I'm just wondering what figure I should be using to reference myself with everyone else, such as AsianMale's 30 million count.

I've been on the combo drugs for about 6-8 months? About a few weeks ago, I came back for my 3rd/4th? scheduled visit and to see my results after a 4 month interval (like I said, I'll get the exact date for everyone asap, sorry...). For now I'll type what I remember off the top of my head.

2-3? months on the combo:
HEP B VIRAL DNA QT                                      300,000ish H     <100 IU/mL

4 months later:
HEP B VIRAL DNA QT                                      800ish H     <100 IU/mL

At the moment, I'm HepBeAB negative, and HepBeAG positive.

Please feel free to ask any questions, and hopefully I'll be able to do the same as well as provide answers. Thanks everyone!

[cajim]

Can anyone help me with reading those numbers? I know they're in some type of units, both meaning the same count...I'm just wondering what figure I should be using to reference myself with everyone else, such as AsianMale's 30 million count.

--Your high HBV DNA usually means you are HBeAg positive.  Is that right?  If yes, your high DNA does not necessarily mean heavy liver damage.

What are your ALT and AST?

[Sharp7]

copies/mL is a more standard unit. I have seen the conversion of IU/ml change based on which specific PCR assay is used. I have seen some people use a x5 conversion factor, but one of the times I got the count report, the report specifically asked for a x7 conversion factor for copies/mL.

Most HepB journal papers use copies/mL (sometimes expressed in log10) as the unit of measurement (and very few use IU/mL or pg/mL). Based on that, when I see someone omit the unit, I assume they mean copies/mL.

[stevenNYer]

"hepbinme":

As per our forum rules, please copy and paste your question to a new thread.  We try not to take over someone else's thread.  This thread posting should be related to AsianMale's situation.   We'll be happy to reply comment to your own thread.

[hepbinme]

I apologize. I should read the forum rules...was too anxious when I found out that there are others out there relating. Sorry! =]

[joethestrong]

I'm 52 with VL 80 mil, normal liver function and biopsy, in immune tolerance phase [?]. I was suggested to start Baraclude because of age, got some severe side effects but continue on now for 16 months. VL. were down to 3,000 before rebounding to 12,000. and start adding on tenofovir.

I think this whole things of early general prevention could not be right. Monitoring should be better since I'm 52 and still ok. What if you start antiviral drugs in such and early ages and have to continue for very long time. Don't make sense. The professional have to find accurate risk of having cancer  to support the general prevention.

[cajim]

1.  When did you first test positive for hep B
2.  What treament(s) did you go through?
3.  At the time you started Baraclude, what were ALT and AST?

[joethestrong]

1.Didn't know when first contacted [ could be vertical.}. But first tested hbv positive 30 year ago, [ at 22 in univ.].
2.Normal ALT & AST, normal biopsy, consider to start tx. due to high viral load [ 80 mil.] and age in risk group.
3.Started with Baraclude 0.5mg 16 months ago. Start adding on Viread 300 mg 1 month ago.

[cajim]

I can see the logic of your doctor's starting baraclude.  How do you feel now?  normal eating, sleeping, working, family life?

[joethestrong]

If stop taking drugs is of great danger, then I think it's must be informed prior to the start of tx. so any patient can weigh his/her own risk.

[joethestrong]

I feel normal so far but begin to worry about the long term effects of both drugs. Want to quit the drugs, any suggestions?

[cajim]

"If stop taking drugs is of great danger, then I think it's must be informed prior to the start of tx. so any patient can weigh his/her own risk."

--Agree 100%

Want to quit the drugs, any suggestions?

--Absolutely have a doctor to follow and monitor you.

[bram44]

I was recently diagnosed with chronic HBV. With HBeAg(-) and HBeAb(+). Viral load 90,000 copies per ml.

All other tests seem normal. My doctor suggested to use Viread.

Can anyone in this forum suggest whether this is a better option than using Baraclude 0.5mg ? Especially side effects. Should I be using Baraclude first ?

Also I am taking Cholestoral medication (Niaspan 500mg +aspirin 83mg). My cholestoral levels are normal and thinking of not using the medication.

I was never treated and my AST ALT levels are at the high end of normal range (they were normal a year back).

Appreciate any suggestions.

BTW - I am from south India and presently have no symptoms and feel pretty healthy.

Thanks for posting very useful information.

-bram44

[cajim]

Viread, Baraclude, about the same in potency, side effects, etc.

Also I am taking Cholestoral medication (Niaspan 500mg +aspirin 83mg). My cholestoral levels are normal and thinking of not using the medication.

--Do not know enough to comment.

[bram44]

All the material I read so far is indicating HBeAg (-) the treatment is possibly life long. Why is this ?

Can one stop the treatment after achieving low levels of DNA and monitor the level ?
Are there any studies done on this aspect ?

Taking a drug indefenitely is a bit scary thought. It would be nice to understand the "rules" for stopping use of the medication (or restart).

My virus Genotype is A - if that makes any difference.

Are there milder versions of Viread or it comes in only one dose ?

cajim - thanks for responding. You have gathered a lot of useful informations for people like us.

[cajim]

All the material I read so far is indicating HBeAg (-) the treatment is possibly life long. Why is this ?

--Antivirals control only, don't cure.

Can one stop the treatment after achieving low levels of DNA and monitor the level ?

--Needs doctor's monitoring.

Are there any studies done on this aspect ?

--Many.  Type "flare" into google.

Taking a drug indefenitely is a bit scary thought. It would be nice to understand the "rules" for stopping use of the medication (or restart).

--Agree.  The cause is resistance to the drug.

My virus Genotype is A - if that makes any difference.

--Yes.  I remember reading something about it having a better chance to be cured (HBsAg(+)) with IFN.  Go through this:

http://www.medhelp.org/posts/show/492008

Are there milder versions of Viread or it comes in only one dose ?

--Not sure.

[bram44]

The following link gives lot of information on various tests etc...
You need to create a login (for North American users)

https://online.epocrates.com/noFrame/

[kaiming]

Hi All,

For those who have helped to educate me and provide support in this forum, I'd like to sincerely thank you. It's been about 6 months since my last post, and I'd like to provide an update to you and to anyone else who may stand to benefit from my experience. I know if I had access to someone in my situation 6 months ago, I'd be ecstatic and would have asked many questions. Therefore, I'd like to be as open and detailed about my experience as possible.

Since my last post, I decided to continue taking the herbal cocktail tailored to treat hepatitis and postpone treatment with Baraclude and/or Viread.

As of the end of June, my HBV DNA level was 200 million copies/mL; that's an increase of 187 million copies/mL in 6 months.

It was perhaps the most difficult decision I've had to make, but I did finally start taking Viread (solo therapy) on July 2nd. It was difficult for a variety of reasons:
- cost of roughly $1800 for a 3 month supply (what if i no longer have insurance?)
- possible damage to the kidneys (isn't a bad liver enough to worry about?)
- pressure from family members to take the natural approach with herbal remedies (what can I say, they're stubborn when it comes to western medicines with many side-effects)
- potential to end up worse than I started if the virus mutates
- one more crucial thing to remember to do everyday (as if my life isn't stressful enough)

I had decided to take the plunge to start treatment, and for my situation there were really only 3 options: Baraclude alone, Viread alone, or Baraclude-Viread combo therapy. The "benefit" of Baraclude alone is that if the virus mutates and Baraclude becomes less effective, then Viread can be added, as it has been shown to be quite effective as a "second line of treatment" in combination with Baraclude. The other two options seem to be resistant to virus mutation, though not much data is available and perhaps the test subjects just haven't been in treatment for long enough for mutations to occur.

Here's my interpretation. Baraclude is weak. If it fails to control the virus, add on Viread, the more effective drug. Or you can start with both. Or you can just start with the more effective drug. Known side-effects for each drug are about the same.

So I ask, why would I take both when Viread alone seems to be just as effective and resistant to mutation? If I take both, I'm risking potentially unknown drug interaction issues, more side effects, and a heavier financial burden if I lose my insurance. And why would I want to start with Baraclude, help the virus to become stronger, then try to fight it off with both when I could have not helped it to become stronger/different in the first place?

Thus my decision to go with Viread.

Now my experience so far:

Day 1: Took Viread in the morning with breakfast. No side effects until 11pm. Felt quite nauseous, had a headache, and had to lie down. After 30 min, the symptoms eased, and I went to bed soon thereafter.

Day 2: Woke up and felt normal, no more nausea or headache. Took Viread in the morning with breakfast. Again, no side effects until 11pm. Felt nauseous, but not as much as on Day 1. Light headache as well. Went to bed right away, since that seemed to help on Day 1.

Day 3-4: Took Viread in the morning with breakfast. No symptoms all day. Went to bed earlier to avoid the nighttime nausea.

I feel like I've been getting tired earlier since I've been on Viread, though perhaps it's just a coincidence that I've been really active these first 4 days.
If anything changes and I start experiencing side-effects again, I'll try to keep you posted.

Any feedback would be greatly appreciated regarding your experience, or the detail of my post. I'd like to keep posts as helpful and concise as possible.

-AM

[AsianMale]

I didn't realize my friend was logged in when I submitted the last post, but yes, it was indeed mine.

-AM

[bram44]

I was diagnosed on May 27. I had to undergo tests to ensure the side effects are minimum.

I read frantically a lot of information on Viread. Got my medicine, but was hestitating to start.

My doctor says this is not a life-time commitment, rather a long term commintment (possibly 3 years or less). Once the DNA level comes to acceptable level (if not 100% loss of HBsAg), regular monitoring is needed.

I started taking Viread on July 2nd (night after 09:00PM - I eat very late).

I stopped exercising (just doing minor streatching). I don't feel weak, but the anxiety or anticipation of stuff is more than the side effects.

I guess ignorance sometimes is a bliss.

My doc asked me to get Creatinine Clearance test done, to ensure the damage to kidney's is avoided, by adjusting the dosage.

Remember this drug is cleared by Kidney function and one should have sufficient muscle in the body.

I really wish there is a viable "natural therapy", but given our fast paced lives, we may have to live in an "Ashram" for months with strict diet and herbal remedies. I am not sure we have such a talent available in this day and age.

Wish you and all safe recovery.

[iaas]

Hi everybody,am a worried mom whose husband was dignosed with the chronic HBV  3yrs ago.He was on pagasus for a year.which he was doing fine but also lost a great amount of weight.his DOC then put him on the baraclude(entecavir)but he never paid attention to his medication and was drinking alcohol at the same time,till just recently he became seriously sick and was told the virus had flared up again.so he`s now on both baraclude and viread.Am so worried  now because he feels so weak and frail,his eyes  are yellow.They evaluated him at the hospital for a liver tansplant but was later told the results  of the liver biopsy was better than they thought.
since the hospitalization l`ve been going to the hospital with him every week to check on his labs.All they keep saying is enzymes are maintained but they have been giving him vitamin k injection for coaguation.
Am new with this  diagnose so i dont know much about the lab values but the next time we visit the DOC I`ll get some information to share with you all.
THANKYOU ALL for the information

[bram44]

It has been a little over a month since starting on VIREAD. First few days felt numb-feet. I noticed a little fat on the belly - may be I am eating much and not exercising.

One occasion I had couple of drinks and felt drowsy the next day (and did not feel like eating). One advise for people with HBV infection is to stay away from alcohol. But my doctor suggested "occasional limited social drinking" is ok.

I feel normal, like as usual. I will be getting viral load testing in October 1st week.

[Jasminetruong]

first of all, i'd like to thank everyone here that have posted their experience and to be honest, reading this  im experience mixed emotions. Firstly, relieved and secondly, afraid at the same time.

I was diagnosed two years ago but being me, i ignore every bloody test and advice from the docs. I saw a specialist about my condition in july 2008. Thinking that maybe i placed on a few kgs that increased my ALT readings. 6 months later, my ALT reading is still high. Therefore, i started treatment on Entecavir. I've been on that for 7 months now and because of the symptoms im getting such as hard of breathing and pain in the heart at times, the doctor prescribed me Viread. I'm worried about taking Viread and everything in the info pamplet is "unknown". I'm 25 and possibly in the next year of so or two years, might start a family. what are the effects ? I know its a NEWER version of entecavir. I'm waiting a call from my docter right now to ask him all these question but the last thing i need is another symptom. Entecavir has given my not only pains and discomfort in the heart but also discomfort in the bowels.

my alt reading is 28 which is normal but the hbv is still active hence, i need to continue taking this. man, this is going to be a long journey for all of us !!

Jasmine

[AsianMale]

To those of you who are affected or know people who are affected by Hepatitis B, thanks for sharing your knowledge and experiences with others. This is how we can help each other make informed decisions about which treatment path to take. If there's anyone else like me out there, (s)he will be very thankful for any information you can provide.

Here's a quick update about my situation:

Test Results, Late June 2009:
    HBV DNA ULTRA QNT (or Viral Load): > 200,000,000 IU/mL
    ALT: 294 Units/L   (21-72 is the normal range)
    AST: 112 Units/L   (17-59 is the normal range)
    e-antigen positive, e-antibody negative
    Everything else was normal

Early July 2009:
    Started taking 300mg Viread (Tenofovir) daily

Test Results, Early October 2009
    HBV DNA ULTRA QNT (or Viral Load): Not Detected
    ALT: 43 Units/L   (21-72 is the normal range)
    AST: 21 Units/L   (17-59 is the normal range)
    HEP.BE VIRUS ANTIG: Negative
    HEP.BE VIRUS ANTIB: Positive
    (I'm going to assume the last 2 mean I'm now e-antigen negative, e-antibody positive. Can anyone confirm this?)
    Everything else was normal.

Besides having headaches the first 2 days of taking Viread, I haven't noticed any side effects. I'm proud to say I haven't skipped a day of Viread and I haven't had any alcohol this year. I know that skipping a dose of any of these drugs can be a very bad thing and you should do all you can to avoid it.

-AM

[SamXYZ]

All,

Please post your VIREAD and Baraclude experiences. Any one here taken these for more than a year?

[hbvisok]

Congratulations! It looks like pretty successful for you. I just finished my first bottle of Viread today. There wasn't any question when my doctor asked me to start on Viread. He said he just come back from a workshop and the University professor suggested to use Viread first. I had my blood test done last week and will have another one in 4 weeks to monitor the progress. Hopefully I can reduce my viral load in another three months too. The doctor did say that I have to take the drug indefinitely.

The Viread cost around $670 per bottle (30 pills) and $50 less than Baraclude in Walgreen here in Florida.

One more thing, I am 46 year old. I have been in "excellent health" and had a rather normal life with two teenage kids. They had vaccination when they were young but not at the birth. I was so relieved when the lab results come back showed HbsAg- for both of them.  That was the best day in my life. I won't have another day like that.

[ambiance3021]

Hi, I am new to the site and have read your journey with Viread.  I was wondering if your doctor every suggested an Interferon treatment.  I am scheduled to start my first dose of Pegasys this Friday and am very anxious, but I know that I won't ever have to deal with the possibilities of the virus building up a tolerance to an antiviral pill as that is not an issue with Interferon treatments.

How were you able to finally choose what type of treatment to go with?

Thanks!

[bram44]

This is one of the best results I have seen in this forum. 200million to undetectable in less than 6 months.

Since you converted from eAg +ve to -ve, you could stop treatment with your doctors advise.

[AsianMale]

To my understanding, Pegasys is more effective for certain genotypes. My genotype (B) does not happen to be one of them. I believe efficacy with my particular genotype was the main reason my doctor recommended I go with either Baraclude or Viread.

Moreover, Pegasys has more side effects and requires a weekly shot; I prefer less side effects and a daily pill.

In the end, I had spent countless hours researching data from any study I could get my hands on involving all the treatment options I was aware of. I chose my treatment path based on number of side effects, efficacy, drug tolerance, and experience from knowledgeable, experienced patients (as in this forum). I hope anyone needing to make this difficult decision will do their own research; even if the decision remains the same, at least you can feel you made a more informed decision.

I wish you a most successful treatment. Please keep us updated on your progress.

-AM

[jhakas]

HI All,

A simple question :

Person 1 :  Was hbeag + ve goal of taking antiviral drug to turn hbeAG -ve and then stopped treatment

Person 2 : Was hbeag -ve already and goal of treatment is to keep viral load und .. and have to take the pills probably for a long long time

my question is after the person 1 who is now hbeag -ve is in the same boat as person 2 who was alredy hbeag -ve /// so WHY DOES person 1 now, after being hbeag -ve does not need to take the antiviral for life long as person  2 ?

[AsianMale]

I presume Person 1 has undergone antiviral drug therapy and not only is e-antigen negative but also has a HBV DNA level that is UND (undetectable). So, Person 1 can stop treatment because the virus is no longer actively replicating (which typically means normal ALT levels with minimal or no necroinflammation in the liver).

Since Person 2 is e-antigen negative and will be treated, I assume Person 2 has HBeAg negative chronic hepatitis B, which is characterized by HBV DNA levels above 2,000 IU/mL and continued necroinflammation in the liver. These patients tend to be older and have more advanced liver disease since HBeAg-negative chronic hepatitis B represents a later stage in the course of chronic HBV infection. Treatment is continued until Person 2 is HBsAG negative. And yes, HBsAg clearance may take a long time.

That said, Person 1 is not completely in the clear. Person 1 has a 4-20% chance of once again becoming e-antigen positive.And even if Person 1 remains e-antigen negative, e-antibody positive, there is still a 10-20% chance of reactivation of HBV replication. Thus, Person 1 will undergo life-long blood tests and possibly more treatment.

I hope that answers your question.

-AM

[aiqi]

(1) My wife was found to be a HBV carrier since 1996. Starting from 2008, she feel some pain on the liver area, but blood test always show normal liver function. In June 2009, my wife did a liver biopsy and it is G2S2, although her liver functions are always normal. HBeAg negative, HBsAg positive and DNA 2000000 copies/ml. We already have child, so she starts to take Viread in September 2009. By end of December 1009, her DNA is down to 1000 copies/ml. She feels much better.

(2)Two years ago, the untrason found that her liver has two lesions, very small. The MRI cannot confirm existance of lesions. Two months ago, she did one more untrason, this time only one lesion is found, another one disappears. Then she did MRI again, and MRI still didn't see any lesion. Doctor said that she doesn't need MRI any more, only untrason followup in the future is needed.

(3)When my wife's HBV DNA is rising in 2008, she is also found to have Rheumatoid factor positive. In December 2009, after taking Viread for 3 months, her RA factor also become negative. The doctor said that the HBV may have caused the RA sympton. Hopefully, she is right. Otherwise, it is tough to have both HBV and RA disease. Because medicaiton for RA will supress the immune system and that is not tolerable to a HBV patient.

[feelzhealthy]

Hi all!

I stumbled on this forum after Googling on hep B and Viread. I've been on Viread for almost 2 years now and I wanted to share my experiences.

I was diagnosed with Hep B 4 years ago. I was born in SE Asia and probably contracted it from my parents. I'm male, 32 years old.

I was on Baraclude when I was first diagnosed, but my first doctor wasn't that great and didn't give me all the information that I wanted. Overall, I felt more energetic during almost a year of treatment. I had a few side effects such as nausea, but nothing major.

I eventually dumped my first doctor. I stopped treatment for a year and found a gastroenterologist that was excellent. He didn't prescribe me Viread right away since Gilead (its manufacturer) was still waiting for FDA approval. Once it got approved, I was put on Viread 300mg daily.

I had routine checkups with my gastro doc for these past couple of years and he was amazed by the progress. My viral count was originally in the billions (yes, billions), but my last visit a few months ago showed numbers in the thousands. He actually called me himself in the evening to give me the good news (which apparently he never does). My other vitals (I don't remember all those weird HB numbers) are at or slightly above normal. My sonogram was normal. I have perfectly smooth liver lining -- at least that's what the tech told me.

I've had no side effects whatsoever with the treatment. I feel fantastic and I actually would miss not taking the pill every morning with my breakfast. I must mention that I strive to stay in great shape. I have a healthy diet and exercise strenuously 3-4 times a week.

Also of note: I do drink and have known to binge drink on the weekends when going out to bars and restaurants. I don't drink daily, however. My doctors did recommend stopping altogether, but it is what it is. Also, I've been taking supplements as part of my workout routine. Despite all this, at least I feel great and the test results seem to show that everything is fine.

I recently moved out to California from Texas and will be seeing another gastro doc in a couple of months to see if I need to continue with the pills. My last doc mentioned in passing that it might be possible that I stop taking Viread for a few weeks to see if the viral load increases and extend my time off if it doesn't. I'll have to see with this new doc, but I have feeling that I'll continue taking it. From my experiences with docs, they seem to push treatments and pills as much as possible. It certainly doesn't hurt the medical industry when these pills cost $500 per 3 month supply AFTER insurance!

I hope this helps!

[Sharp7]

Welcome to the group.
I wish to respond to one statement of yours:
"From my experiences with docs, they seem to push treatments and pills as much as possible."

If you develop the habit of going through the latest research papers, you can make informed decisions yourself, and don't have to get anything pushed on to you. All existing data suggests that the viral load will rise drastically unless the patient meets some very specific criteria (end points).

[leec21]

I acquired HBV from my mother and am on Viread and also Chinese herb medicine at the same time for the past year. The doc who prescribed my herd medicine told me it's ok to take Viread as long as not to take them together and give it at least 3 hours between two types of medicine.

The only side effect since i took Viread is headache. However, i used to have headache once a while, it just happened more frequently after i took viread. But it goes away after long sleep. It's very important for Hep B patients to get enough rest.

My last two blood test results are very good. My viral count has dropped to "undetectable" level. Hopefully it will be keeping that way.

[bram44]

I am on Viread for last 9 months. Started with viral load of 30000 IU/ml (90000 copies/ml), with eAg -ve and HBV genome type A.

Viral load became undetectable in next testing (which is after 3 months). I continued to take medicine and still the viral load is undetectable. AST/ALT readings are normal (mine are always in the normal, even with the viral load).

My doctor asked me to stop taking the medicine after 12 months of use and monitor the viral load every 2-3 months.

Thought this is something useful for all eAg-ve (and eAb+ve) patients.

On the flip side, going off and back on if viral load increases,  has a possible mutation of virus. However the test for DBV Genotype already reported there is no current mutation. With no viral load, I am taking my doc's advice...

[bram44]

correction  : After starting Viread, got tested after 1,3,6,9 months.

[Sharp7]

The end-points for treatment of HBeAg negative Hep B were not clearly defined the last time I read about these things in detail (that was over a year ago... and I have not kept myself up to date properly). Back then, the consensus was that if the VL stays undetectable for a year, try stopping the meds.

Anyway, from personal experience (I am HBeAg+, unlike you) I recommend testing VL a lot more frequently than every 2-3 months. In fact, for the first 2-3 months, I would monitor it at every 2-3 weeks, with progressively larger intervals, as long as the VL continues to stay undetectable.

The chance of mutation is low if the VL is low... and so, I would go back on meds at the first hint of an increase in VL.

[Sharp7]

sorry... when I wrote "I recommend testing VL a lot more frequently", I meant it in the context of stopping meds.

Anyway, I think you know quite a bit about the disease, and you would have understood me anyway ;-)

[bram44]

Still the recommendations are the same. For eAg-ve patients who did not s-sero convert, need to be monitor lifetime.

However there is no consensus on getting off meds. But they are suggesting to stay on meds for 48 weeks (even if the VL is UND after 1 day of taking med) and go off meds. If VL stays UND no issues, otherwise need to go back on meds if VL continues to go up and crosses the 2000 IU/ml mark.

BTW - how is Germany treating you?

[rita165]

please anyone can help me??? i am taking viread and now i have insuline problems if i stop viread is there other medecines and treatment i can take ??and if i stop it the side effects will stop??? i will get normal insuline or no ???

[Wildwest8444]

My Doctor first starts me on Hepsera.  After 1.7 years, he switches me to Viread.  I have been on Viread for 1.3 years.  On couple occasions, I would forget to take my meds.  I finally have purchased a watch, going off  6:00pm; 6:15pm; 6:30pm to make sure I don't miss any of my medicine.  
I recently have been given promising news.  I am told that my body has begun building antibodies.  My current Virus DNA Ultra Qunat low and high is <100 copies/mL. <19^10  <19 IU/mL; which means my body have little sign of the HepB virus.  In fact my body has begun building anti bodies; my HBsAB (surface antibody) is 6.9^9 mIU/mL.  I am told that if my antibody increase to over 10, I would be consider immune.  
I exercise 3 times a week; mostly pull-ups and setups with some running. I also try to eat more vegetable while cutting back on red meats.  I have little side effects from Viread.  Beside my meds, I also take some daily vitamins.  I will turn 40 this year.  With this promising news of antibody, I will try to exercise and sleep more consistently.  
One important Note: For people who are thinking of using traditional medicine, my doctor tells me to avoid taking any herbal medicine or liver supplements; these products often can do more damage to the liver than good.  

[stef2011]

everything is correct about hbsab and do not change anuthing on your therapy but in your posts there are very wrong things for other people who might start treatment

Virus DNA Ultra Qunat low and high is <100 copies/mL. <19^10  <19 IU/mL; which means my body have little sign of the HepB virus

this is not exact you just have low replication, hbvdna is not hbv virus, only hbsag negative and hbsab is immune control of hbv but virus is still there but cannot do anytthing because totally controlled by immune system.
hbvdna und and normal alt <30 is equal to no liver damage

My Doctor first starts me on Hepsera.  After 1.7 years, he switches me to Viread

i hope he did it in the past and doesn t do it now
hespera is an old failed hv drug, gilead tried to make some money on hbv but toxicity is too high and active so low that one pill of viread is equal to one bottle of hespera, same ting about toxicity.both drugs are made by gilead but hespera is not an hbv drug from 2009 guidelines.

once you have little hbsab and low or negative hbsag you are close to seroconverting, i am very happy for you

as to the question baraclude or viread
definitely viread more potent, no resistance

[bram44]

Thought of sharing my results - which are not good.

I syopped Viread after 1 year of treatment in July 2010. Had viralload UND during treatment.

Now with latest test the viral load is 27000 IU/ml (150000 copies) - tested on 09/23/2010. AST 38 and ALT 73.  AFP is 2.4 which is good (tumor marker test).

Seems it is a flare. I may be going back on treatment.

Any suggestions/comments - SteveNYer/cajim/xtefano/sharp and others?

Also any alternative treatment options - please share.

[cajim]

Any suggestions/comments - SteveNYer/cajim/xtefano/sharp and others?

--Antivirals for most people are one-way ticket, regardless how impressive the lab results look when on them.  They also hurt your liver with their toxicity as you know.  My suggestion as I am practicing too is to take a lot of courage and discipline to eat and live in a way that help your liver even when you cannot stop Viread yet.  See here:

http://www.medhelp.org/posts/Hepatitis-B/How-I-manage-my-HBV/show/1337595

[stef2011]

you made the wrong choice by old data, from about 2008 we know hbe negative and hbeab pos means nothing in terms of immune control of hbv, hbe neg just means less aggressive virus and doesn t mean immune control of virus

now we know that keeping hbvdna und for more than 3-5 years can reverse liver damage/cirrhosis and that 9-10years make hbsag negative/very low, cccdna negative/very low, eradication will probably happen at 15-20 years, we have to wait till more patients reach that time on entecavir or tenofovir, most potent drugs on hbv

now we also now that interferon+potent nucs like telbivudine and data not pubblished yet entecavir/tenofovir, lowers hbsag very fast.telbivudine+interferon can have heavy sides so for now this combo is studied and not used yet but we have to consider it lowered hbsag 1,5log in 24 weeks only (hbsag is 3log on hbe negative)

my suggestion is keep using tenofovir and add nitazoxanide if still hbe negative so that hbsag will get lower and hopefully negative by 1-2 years, the combo tenofovir+ntz might also prevent resistance too in theory but there is no data on both tenofovir resistance (never happened until now) and ntz resistance prevention

[bram44]

Thinking of going the way you suggested.

Seems I have this virus as a child. Last year I gor ultra-sound and MRI, they were good.

Thanks!

[bram44]

Is NTZ available over the counter? Also if viral load is und, can we consider the damage to liver cells in minimal vs uncontrolled viral load?

[stef2011]

if available monitor also fibrosis by fibroscan, baseline now and after 1 year hbvdna und, ultrasound can only detect cancer not liver damage or fibrosis, mri is useless only in case of liver cancer can be useful to understand what type of cancer

in some countries it is available without prescription especially south america, in Us you can buy at lupin distributors, or simply buy from canadian pharmacies, if you have problems to get i will send a private message with pharmacy where i buy it.check our threads about alinia on dose (1.5g daily min) and way of administration.you might also take NAC (strong antioxidant) this boosts liver function, kidney function, immune system function, lowers the minimum toxicity of drugs over the years.NAC in europe is over the counter.

Also if viral load is und, can we consider the damage to liver cells in minimal vs uncontrolled viral load?
hbvdna und and normal alt is no liver damage at all and regression of all liver damage reached by years of hbv replication
ncontrolled viral load has liver damage and leads to cirrhosis or liver cancer especially when more than 2 logs, it takes years but that's the end

now that you have hbvdna detactable do make resistance test so that you are sure you have not developped tenofovir resistance or you had resistance mutations already before starting therapy

[cajim]

Thinking of going the way you suggested.

--How can you?  The two ways are completely different: one is a complete trust and reliance on antivirals and the other is the exact opposite.

[stef2011]

i am sorry i don t agree to the healthy life method alone, it can be of help but the virus will go its way whatever you do unless hbvdna is complitely und and alt very low normal the rest is just lucky genetics/type of hbv mutants

me, healthy life, good diet/food, low hbvdna or und, low alt most of the time with alt flares from time to time to clear infected cells without hbv eradication, frequent blood checks

my sister, unhealthy life, no blood checks for most of her life, higher hbvdna, higher alt, worst baseline biopsies when 20yo than my biospies

at 40you i ended up with cirrhosis, a very small focal liver lesion, probably a HCC, that disappered with etv therapy and hbvdna und, all virus mutants that makes damage towards cirrhosis and liver cancer even with low hbvdna, the key of my situation is the muatants which are the prevalent form of hbv after 35-40yo

my sister, no cirrhosis and probably no mutants.

since me and my mother developped cirrhosis she will make hbvdna und by ntz or ntz+interferon if ntz not enough.my mother made it to cirrhosis with wild type virus and now transplanted, feeling very good with hbsag negative.

we have other relatives dyed of hbv cirrhosis/liver cancer dispite healthy life, unpolluted areas, fresh foods mainly from our town or own fileds, almost no food from industry and all feeling good until couple of months before death

[April63]

Hi, I was waiting for your post. To see how you're doing.Sorry, the stopping didn't work. I guess it was much too early. VL is still low and AST and ALT not too high either. If it's a flare up it's not too aggressive,right? Going back to Viread, or Viread+Alinia should bring VL to und soon again. Wishing you all the best-April (husband on Viread,second year)

[stef2011]

To: bram44 and april

the problem is these drugs have no effect at all on virus, they just interfere with hbvdna lowering or stopping replication but the virus is cccdna which is all there to rebuild all viremia again, unless there is an hbsab antibody which blocks viral entry in the liver cells there is no difference in terms of immune response before and after hbe negative and almost all patients with hbe seroconversion will gain back pretreatment levels

with interferon the situation is different because if you respond to interferon you also lower cccdna but even in this case if there is no hbsab antibody to block viral entrey the viral load will rise again although very slowly in years

the suppression of hbvdna is needed for about 10 years to slowly decrease cccdna/hbsag so endpoint to stop therapy without infection restart is only hbsag negative

in my case even if i make hbsag negative/hbsab i will have to continue antivirals until crirrhosis regression because even with these antibodies there may be slow amount hbvdna and make damage which is a lot for a liver with cirrhosis and of course nothing for a liver with some fibrosis

[bram44]

We all read so much about this virus and still don't know how each person responds.

I will go on Viread and will start Alinia after consulting my doctor.
Stefano has been very vocal about Alinia for a while on this forum and it's effect on reducing HBsAg quantity. I am always confused with reduction in HBsAg quantity and DNA undetectable. I used to think both are same.

As cajim has been patiently posting in the other thread, it is great to follow a life style that gives liver plenty of rest. But with our busy life style and families to take care, it is extremely difficult.But it is certainly great idea to keep the bar higher.

For me with medication the viral load is getting down to undetectable level in 1 month and stayed there until I stopped. In the 3 months I stopped it came back close to the level where I started, I was hoping it will gradually go up, but not so quick.  From undetecable, how could it raise that much? What is the multiplication factor ?

Thanks for looking into my post and giving your suggestions...

[cajim]

Hi, stefano170669,

I am sure people at HBV forum are grateful to you for your knowledge and input that have help so many people.

I also deeply appreciate your sharing your HBV experience and those of your family with the intention of helping others.

Carefully reading your post above, the following seem to be your positions:

1.  You, your mom and relatives of your family have been having a healthy life style yet you have cirrhosis, your mom has transplantation and relatives have passed away; your sister on the other hand has been having an unhealthy life style and treating HBV as if it were not there yet she is in better shape with no cirrhosis, transplantation, etc.

2.  Antivirals have helped you erase the focal liver lesion and your mom change HBsAg to negative.

With regard to Position 1, have you considered the following?

1.  Another difference between your sister and everyone else is: she has not been repeatedly hurt by chemicals and diagnostic procedures;

2.  Not all healthy life styles are the same.  For example, do you slow cook your meat and fish for 12 hours and only drink the soup throwing out the rest?  Do you try to be sleeping from 9pm to 3am?  Are you well controlled in sex frequency?  Do you do gut purge monthly? etc.

3.  Compromised liver means weakened protein synthesis and detoxification ability.  What in your healthy life are specifically planned to help your liver in those two areas?

With regard to Position 2, I certainly hope antivirals are helping you and your mom in ways you describe.  I am sure you are very aware of the chemical sides of drugs and I hope you are doing things to keep their effects to the minimum.  May I ask why your mom had to take the transplantation step and when was it done?

[bram44]

Before starting treatment I got a ton of tests. One of them is Geno type (mine is A) and mutation profile (I had no PRECORE/BCP mutations detected).

The test result also mentioned, no drug resistance expected. Last 3 tests show I have eAg-ve (eAb+ve). I guess that stays that way rest of my life. I did not read anyone converting from eAg-ve to eAg+ve (unless they had susequent infections).

The way you explained cccDNA producing and increasing viral load and anti-virals interfering with reproduction, I am still not able to follow.

For example say one has 1000 cccDNA producing 1000 virus copies each day, antivirals mess with 1000 virus copies and 1000 cccDNA still there?

Though it is my question, sounds dumb :)

[stef2011]

With regard to Position 1, have you considered the following?

she did interferon when still experimental and made hbe seroconversion, hbvdna und and normal alt.
she was already fibrosis 2 at 19yo and interferon saved her from a rapid worsening from so young, she only made alt checked in the following years because she didn t want to make interferon again.prior to interferon she had active hbv with abnormal alt since 16yo

my mother was discovered because of a heavy bacterial infection and close to dye so they made all blood checks, at the time there was no vaccine or awarness about hbv and it was like flu in italy (guess worst than china), everybody had it, that's why most of the hbv studies are from italy

she took interferon and lamivudine when experimental in the 90s and she was very lucky because interferon was followed by lamivudine and hbvdna was und by 4 weeks, so even if nothing was known about it she made the correct choices to get the best.
without interferon and lam she would have dyed pretty fast, she was put first in the transplant list and had it in one of the best hopsitals for this in turin.actually it was almost too late for transplant according to the main researchers but she found other very good specialists and was put in the list anyway

after transplant there is no more cccdna in the liver so those with antiviral therapy before transplant makes hbsag negative and she is doing very well, actually she is in better shape than me and my sister although transplant and her age

we have been very lucky because we never used normal doctors but mainly researchers so we avoided wrong choices and wrong drugs that can lead to hbv resistance and of coruse me and my sister waited for drugs like tenofovir or entecavir because researcher told us they don t work from 2000

[stef2011]

so now we are using drugs that have no toxicity and no resistance issues, me entecavir and ntz and my sister ntz.
we make fibroscan and ultrasound every 6 months to really know where the liver stands, my sister will have her first fibroscan in october and until then it is not possible to say if she has cirrhosis or not 100%, also hbsag check will be in october but her was 17300iu/ml so there is along way even if ntz works.
she will also have rt mutations test, bcp and precore test but i think interferon prevented mutations

my mother of coruse lam and immune globulins to prevent any possible come back of the virus which have no toxicity, and immunne suppression drugs which can have toxicity but she hasn t had any until now, the only bad thing is she is getting a little fat because she eats too much....

[stef2011]

for example say one has 1000 cccDNA producing 1000 virus copies each day, antivirals mess with 1000 virus copies and 1000 cccDNA still there?

to make it easy, cccdna is the virus template, the masterpiece to remake all virus strains even when all virions are eradicated, it is not the virus, it is hidden inside the cells and cannot be destroyed by immune system or drugs available now.
Once you are infected with hbv there is no way to clear cccdna only complete suppression of virions in decades can eradicate it because the liver cells dye with time and cccdna dyes with them.the cells also duplicate and also cccdna duplicates but with time there is more cccdna dying with the cells then duplicating with the cells

this cccdna produce the pieces the virus is made of, the antigens hbsag, hbcag and so on, but it also produce hbeag and hbsag in great excess that are not used for virus assemply but to neutralize the corrisponding antibodies so that immune system cannot attack and clear the virus

tenofovir and entecavir just block hbvdna so that the antigens produced by cccdna cannot assembly into virions, so they block virions production and infection of new cells but they dont touch cccdna at all

hope it is a little clear and even if it is not scientifically like that is the final result

nitazoxanide activates cellular defences which are blocked by hbv, maybe it blocks antigens exit from the cells like for flu virus, once hbsag is blocked inside the cell it cannot neutrilize hbsab antibodies anymore so with time if hbsag goes down hbsab goes up and neutrilize hbsag.Once the is no more hbsag the antibody hbsab blocks viral entry so hbv is blocked forever, cccdna is still there but the virus is blocked

[stef2011]

interferon is similar to ntz but interferon gets insides all cells while ntz is active only in infected cells so while interferon has very heavy sides ntz has almost no sides

interferon boosts immune function but results on hbv are very poor while sides heavy, i think interferon is very usefull but used in combo with other durgs and at the right time for the right situation.

[bram44]

Thanks!!

I will be visiting India, where I can get NTZ with less restrictions.

[cajim]

I misunderstood you: I thought your sister was never on antivirals.  In this all three of you are on antiviral treatments.  I wish the best for you all.  Your sharing your progresses will really help many newcomers.  I hope all roads lead to Rome.  By the way, what year did your mom underwent the transplantation and at what age?  Thanks.

[thomzz713]

very interesting discusions, I'm just observing how this goes while we are waiting for the exact cure of HBV. . keep us educated with your knowledge and research..

God bless us all...

[stef2011]

i am the one who never took drugs and made the heathy life since i had the most potent immune response, and ended up the the severe damage, but in any case we will know end of october because without fibroscan you have no data on liver fibrosis.biopsy is almost useless on this because cirrhosis can take 5-10 years or as little as one year

now we know that it s the hbv mutations that counts the most, not the immune response or low alt/hbvdna

[stef2011]

about 2000, age more than 60yo, don t remember exactly, the turin center is one of the best in the world probably the best in europe, but that's not enough too i guess t is just god or being lucky

[cajim]

Indeed, your mom is very fortunate for living happily 10 years post transplantation!  It gives hope and optimism to people who need to choose that route.

Thanks.

[almaja]

Haw was your ALT and DNA before you foun out you have cirroses? and how you feealing now ?And did you ever have  pain in your right arm ?

[stef2011]

the key is having hbvdna und and hbsag low before transplant so that cccdna and hbv cannot get to the new liver

another very lucky situation is if the donor has cleared hbv complitely by infection and both cccdna, some of the immunity from the donor gets to the receiver so some hbsab is produced despite immune suppression.
in rome they also made vaccine to increase hbsab for 12 months and about 53% increased hbsab to more than 500miu/ml

for the rest the key is good balance of immune suppression by monthly blood test to keep the right dose of the drug in the blood

transplant for hbv has got very very low thanks to entecavir/tenofovir only people unware of cirrhosis can now get to transplant or those who develop liver cancer

[cajim]

Agree with what you said.

Everything has to be just right to have the level of success your mom is enjoying.

[bram44]

I am sure you may have seen this...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670405/

I am 45 years, so don't mind taking this risk and be a guinea pig :)

Hope the side effects are minimal. We don't have too many choices anyway.

Thanks!

[bram44]

I went over the posts recently of your success, without using antivirals.

Simplifying the information, as I understand it, it seems you are giving liver a lot of rest (eating/resting). The food intake seem to have the "medicinal"impact, combined with other items.

It is great news and it is certainly shows how meticulous and disciplined you are.

However, it would help greatly for majority of people, who don't have time to go through this volume of information. If you can explain a) eat/drink this b) other life style changes
in 2-3 paragraphs and then give detailed information for people who want to read further, would help greatly. Also for non-chinese-reading people, could you please translate?

Just a thought.

Once again thanks for the work you do on this board...

[stef2011]

that's one the studies that made me try ntz together with the safe profile of the drug and the fact that it doesn t affect hbv but intracellular immune response, so no resistance or virus mutation is possible

[April63]

I've been reading your posts with interest. However it make me very frustrated when I read about the importance of value of HBsAg or HBV genotypes and I don't know any of this, when it comes to my husband. I live in Canada yet I feel like I live in a third world country. All we have to rely on is his HBV DNA, his ALT and AST. His doctor doesn't even believe in AFP markers. And this is a very good doctor so there is no point for us to search for another one. Luckily everything is going OK with his Viread therapy but I'm scared to think what would have happened if it wasn't. Thank you all for your time to share your experiences and your knowledge.-April.

[bram44]

HBV genotype has little value in treatment. Research is still ongoing.

AFP marker by itself also is of little value.

I guess Canadians are smart and take what gives bigger value for the buck.

Think about us in US, if god forbid there is no precription drug coverage. Viread costs about $1600 for 90 day supply !!!

[stef2011]

well no it doesn have much importance for the following reasons:
once hbvdna is und it is not possible to know genotype unless biopsy
genotype A and D have hbsag lowering and hbsag seroconversion, other genotypes no
genotype b and c, and especially c are linked with liver cancer, so therapy is always good even if hbvdna is very very low
if you choose interferon genotype d has the worst responce and A the best

[cajim]

How modern people want to read a one-page summary to get the content of three books of over 350 pages each!

The only way to satisfy such a request is a do-list, leaving the whys and hows in the other thread:

Daily:

1.  Drink 1000ml water after waking up;
2.  For breakfast, drink 500ml live fish/beef soup and eat coarse grain food and vegetables to 70% full;
3.  Throughout morning, sip up 500ml of appetizing soup;
4.  For lunch, drink 500ml live fish/beef soup and eat coarse grain food and vegetables to 70% full;
5.  Take a 30 minute walk after lunch followed by a nap;
6.  Throughout afternoon, sip up 500ml of appetizing soup;
7.  Drink 1000ml freshly squeezed vergetable/fruit juice;
8.  Exercise for 30 minutes with sweat and loud sound around 4pm;
9.  No dinner, just drink 500ml live fish/beef soup;
10.  Steam-heat feet before going to bed at night;
11.  Be sleeping in bed 9pm-6am;

Monthly:

1.  If married, have sex once monthly;
2.  One gut purge monthly;

All the time:

1.  Sleep separate from spouse;
2.  Have a religious belief;
3.  Avoid anger, alcohol, chemicals, etc.

Is this brief enough?

[stef2011]

genotype A and D have hbsag lowering and hbsag seroconversion, other genotypes no

sorry forgot to say on tenofovir and entecavir

while interferon lowers hbsag and seroconvert 11% on all genotype but more on A than D

[bram44]

The following gives various genotypes and antiviral responses:
http://jac.oxfordjournals.org/content/55/2/139.full


The following are also interesting reads/posted in the forum sometime back:
http://emedicine.medscape.com/article/177632-treatment
http://www.hivandhepatitis.com/hep_b/news/genotypes.html

Just like treatment options are still getting refined, the jury is partially out for geno type use...

You are absolutely correct in your statements, but if someone does not want to test geno-type that is ok as well, if they are being treated with first level recommended treatment options...

[letsbfriends]

According to my research and my doctors confirmation, Baraclude has a high incidence of cross resistance, specifically with herbal remedies that may or may not have been laced with Lamivudine.  Cross-resistance (ineffectivity) rates of Lamivudine to Baraclude are almost 60% at the end of their 5 year studies.  Lamivudine resistance rates are around 70% at the end of their studies.  1.2% resistance to new patients.  I also took herbal remedies because of recommendations from friends.  Baseline resistance tests would have cost around $200 and not covered under my insurance to see if I was resistant.  Baraclude needs to be taken 2 hours before or after a meal.  Baraclude is pregnancy category C.  Baraclude is about $875 per month.

Viread has 0% resistance up to 3 years.  No food effect, so can be taken before, during, or after a meal.  Pregnancy category B.  Cost about $725 per month.  

Both are processed through the kidneys, both are recommended 1st line agents, both are good drugs.  My doctor broke it down for me and the choice seemed easy.  I received a $0 co-pay card from him for my Viread and I pay nothing for it.  

Baseline DNA just under 3 million.
After 6 months down to 700.
After 9 months undetectable, everything else also normal.

[stef2011]

entecavir is much more effective on hbsag among monotherapy treatments so if there is no resistance and no use of lam it is a better choice over tenofovir, 1mg etv is also more potent on hbvdna suppression, etv has also no sides on long term use.
Hbe negative has 3% hbsag seroconversion on etv and 0% on tnf

tenofovir can't also be used in case of kidneys problems which can be seen only when creatinine/gfr increases during tenofovir use, we will have to wait for new tenofovir formulation to be on the market for this use.Tenofovir is more potent on resistance probably because it stays in the cells more than other antivirals

so i think every case has to be considered deeply because in some cases etv is better and in others tnf is better

Hbsag and nucs from boston liver conference 2010

https://docs.google.com/leaf?id=0B_yFgxI8KNcRNTllYzJjNjctNjg5MS00YmQ1LTliMmMtZDFjYjY4ZTA0MzVm&hl=en

[iphone2539]

hi!! i'm new in this forum...

i was diagnosed to have hep B since 2008. my curiousity keep pushing me and asking my self how i got this since both of my parents are healthy since then i learned it to my sister in law that i got it from her brother since he was my boyfriend. so hurt to know about it cause my boyfriend didn;t told me about his condition, but yah it's done and cause trouble in my life already..

anyways, after i know about my condition my doctor told me to take BARACLUDE and until now i'm still taking it. it's expensive you know!! gosh!!

1.) does anyone knows any health insurance that can help our condition??
2.) is baraclude really effective? my latest lab results from APRIL 2010:

HBV DNA Viral Load ( real time PCR) detection limit:

                   406 IU/mL from millions of virus during my 2008 DNA test

   HBsAg   REACTIVE
   HBe Ag  REACTIVE
   SGOT and SGPT are both normal

and guys i just had my lab test the other day and tomorrow for my HBV DNA.. hope there will be nice result..
  

just wondering is VIREAD  really effective?

please help me guys..

THANKS!!!  


  

[cajim]

1.) does anyone knows any health insurance that can help our condition??

--Are you in the US?  Most insurances here cover it with or without a copay.

2.) is baraclude really effective? my latest lab results from APRIL 2010:

--Depends on what you are comparing it against.

just wondering is VIREAD  really effective?

--It is the newest antiviral on the block.

You have HBeAg+ HBV.

According to AASLD Hep-B Guideline 2009 Update,

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT 40 years, ALT persistently high normal-2x ULN, or with family history of HCC.  Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, observe for 3-6 months and treat if no spontaneous HBeAg loss.  Consider liver biopsy prior to treatment if compensated.  Immediate treatment if icteric or clinical decompensation.  IFNa/pegIFNa, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  ADV not preferred due to weak antiviral activity and high rate of resistance after 1st year.  LAM and LdT not preferred due to high rate of drug resistance.  End-point of treatment – Seroconversion from HBeAg to anti-HBe.  Duration of therapy: IFN-a: 16 weeks;  PegIFN-a: 48 weeks;  LAM/ADV/ETV/LdT/TDF: minimum 1 year, continue for at least 6 months after HBeAg seroconversion; IFNa non-responders / contraindications to IFNa -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, IFN-a/peg IFN-a, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance  ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  End-point of treatment – not defined.  Duration of therapy:  IFN-a/pegIFN-a: 1 year; LAM/ADV/ETV/LdT/TDF: >1 year; IFNa non-responders / contraindications to IFN-a -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >2,000 IU/mL ALT 1- >2 x ULN, then, consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.

If you are HBeAg-, HBV DNA (PCR) <=2,000 IU/mL ALT 2,000 IU/mL—Treat, LAM/ADV/ETV/LdT/TDF may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance; ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  HBV DNA6 months; 2. Serum HBV DNA >20,000 IU/mL (105copies/mL), lower values 2,000- 20,000 IU/mL (104-105 copies/mL) are often seen in HBeAg-negative chronic hepatitis B; 3. Persistent or intermittent elevation in ALT/AST levels; 4. Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation.

Inactive HBsAg carrier state: 1. HBsAg-positive >6 months; 2. HBeAg-, anti-HBe+; 3. Serum HBV DNA 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 ULN, or who remain HBeAg positive with HBV DNA levels >20,000 IU/mL and are >40 years old, should be considered for liver biopsy, and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis. Patients who remain HBeAg positive with HBVDNA levels>20,000 IU/mL after a 3-6 month period of elevated ALT levels >2  ULN should be considered for treatment.
HBeAg- patients:
● HBeAg-negative patients with normal ALT and HBV DNA <2,000 IU/mL should be tested for ALT every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months.
● Tests for HBV DNA and more frequent monitoring should be performed if ALT or AST increases above the normal limit.

Side effects:

IFN-a and PegIFN-a:  initial influenza-like illness: fever, chills, headache, malaise and myalgia. Other common side effects include fatigue, anorexia, weight loss and mild increase in hair loss. The most troublesome side effect of IFN-a is emotional lability: anxiety, irritability, depression and even suicidal tendency.

Lamivudine:  very well tolerated.

Adefovir Dipivoxil (bis-POM PMEA, Hepsera):  Nephrotoxicity has been reported in 3% of patients with compensated liver disease after 4-5 years of continued adefovir therapy.

Entecavir:  a similar safety profile as lamivudine in clinical trials.  Studies in rodents exposed to doses 3 to 40 times that in humans found an increased incidence of lung adenomas, brain gliomas and HCCs.

L-deoxythymidine (Telbivudine/LdT, Tyzeka):  well tolerated when used as monotherapy and has a safety profile comparable to lamivudine.   However, cases of myopathy and peripheral neuropathy have been reported.

Tenofovir:  has been reported to cause Fanconi syndrome, renal insufficiency as well as osteomalacia and decrease in bone density.

[stef2011]

a wonderful update after 48weeks of my treatment with baraclude 0.5mg (entecavir) plus alinia (nitazoxanide) 1.5g daily
i also changed diet with antioxidants known to reduce fibrosis in anima studies:bluberries, melatonin,omega3,green tea

cirrhosis regressed, fibroscan 9kpa about f2 to f3 borderline, since fibroscan can only give higher results and never give lower results it is probably about F2
(13.9 in july, 16.3 in march, 15.9 november 2009, cutoff values for F0 4.0kpa, F1 about 6.5, F2 about 7.1, F3 9.1 and F4 12.5)

this confirms baraclude as the most fast antiviral in cirrhosis regression while viread is better on less fibrosis stages

in december we will check deeply by ultrasound if nodules have been absorbed and structure of the liver slowly getting back to normal, it ususally takes years of hbvdna und to make this while reduction of fibrosis can be faster.it is also important to recheck in january if i can reach F0 at 4-5kpa

[iphone2539]

thanks!!

anyway i'm study here Philippines, i just recieved my new health insurance and yah they didn't include my illness..

it is so hard cause baraclude and lab test are quiet expenssive, without insurance i don't know if i can still support my condition anymore..

and some other thing. this coming days i'll post my latest lab results hope you will interpret it for me...

thanks!!!

[iphone2539]

staying here Philippines , it's not  study.. i'm sorry bout that..but yahn i'm studying nursing now as 3rd year level..

so sad right,? cause i'm in medical field but then i have like this illness.. i just don't know what will be my future is..

[cajim]

Know how to live healthy and practice it will help you.

[jumbojet1]

Thanks alot for shaing your experiences. You people are wonderful human beings.

I have hepatitis b probably since birth. My ALT/AST have been consistenly normal. HBV DNA varies between 1800 coples and 18000 from year to year. HBeAg -ve, HBeAb +ve. Normal ultrasound. I am my thirties. Everything was good, until I had my forbroscan result very recently which came to be 7.1. My doc said my liver is damaged and has asked me to go for biopsy. How accurate is fibroscan. What stage do you thing I am on Metavir? I am scared. How many years of life have I left.

[stef2011]

How accurate is fibroscan.
on europeans and at ranges higher than f2 very accurate, more than biopsy if you make many readings and doctor can read it with all other parameters
7.1kpa is not high but it is the level where you start to worry about treatment

unfortunately all blood tests are useless to see liver damage, i was the same as you but last year i had a alt flare and asked to start theray we checked fibroscan and it was cirrhosis.
if biopsy or fibroscan are not checked all the rest is useless because liver can be any stage of damage and nobody would see it

anyway do not worry too much 7.1 is about f2 damage, i'd avoid biopsy and make fibroscan checks every 4-6 months, the choice of therapy is for hbv eradication not for liver damage only for you since not heavy yet.
i'd try interferon, ntz and possibly lam or etv first just to see if hbv can be eradicated or hbsag lowered

do not go for antiviral only yet because they d not affect hbv and even increase infected cells often, try interferon and ntz first

How many years of life have I left.
many, f2 is mild and it s probably in a balance if your alt are normal

[jumbojet1]

Thanks a lot for for your help. what is ntz?

[stef2011]

nitazoxanide, brand name of drug alinia, generic names nizonide500, nitarid500 and so on

[wonderboy2011]

hi, just read the posts and would like to share with you my experience. I started treatment about 2.5-3 years ago starting from Hepsera for a few months. My HBV DNA was in the hundreds of millions. HbsAG +, HBeAG +. Hepsera did not knock down the HBV DNA level to acceptable level. Then I was switched to Baraclude for a while and HBV DNA was reduced further, but still not to UND level. Then the doctor used Baraclude + Viread. This combination koncked down HBV DNA to UND level. During late 2009, my HBV DNA level came back for unknown reason. My own suspicion was that during that period of time, I drank too much coffee and got diarrhea all the time. I continued on combo and drank less coffee. And HBV DNA level was back down to UND in three months later. Two months ago, my HBV DNA level is still very close to UND. I am still on Baraclude + Viread combo now and will check blood work in another four months.
I am keeping my fingers crossed. Good luck.

[stef2011]

you have been unlucky this doctor is not expert and used drugs out of international guidelines lik hespera, how long have you been exposed to monotherapy and what are the levels of hbvdna and sensibility of the test?

having hbvdna detectable as 10-20 is not of particular danger, i also had a rebound to hbvdna when i lowered ntz in september and it got back to und in 2 weeks

i suggest to monitor with hbcab igM quantitative if available together with hbvdna, in case of resistance hbcab igM have higher sensibility than hbvdna

resistance to a combo like tnf+etv is very very diffficult because both drugs protect each other but if you find hbvdna detectable often you might add nitazoxanide 1.5g-2g daily like in the post, it is active on all hbv mutants since it doesn t act on virus directly.

we cannot have 100% security it can prevent resistance since long trials on many people never happened, there are only 2 reports:
one man with adv resistance who kept combo adv+ntz 2 years, hbvdna na dhbe neg by first yera and hbsag negative  and hbsab pos by second year

one man with lam resistance, ntz+lm and got und in a couple of weeks, unfortunately case study report was only for 6 months so we don t know if he got on clearing hbv

it is also to note that people trying tnf+ntz combo in our ntz group have got hbvdna very fast 2 members in one month and a third very fast, she did nt report how fast but told me she was using half tnf pill since hbvdna fall was immediate

[stef2011]

did you turn hbe negative?
ntz might also help you with this, the virus is less aggressive and have lower possibility of mutation under hbe neg

[April63]

Hello, Happy New Year to everyone!:)
I'd be very surprised if coffee did that to you.
According to the newest research coffee is actually good for the liver.

[stef2011]

No resistance to tenofovir disoproxil fumarate detected on week 144
http://archive.mail-list.com/hbv_research/message/20110103.132127.b1b0e464.en.html

in generl tnf resistance has never been detected on hbv even out of studies for use over 10years so even if hbvdna becomes detectable at low levels so in any case you have nothing to worry on that combo

[wonderboy2011]

Thanks, stefano170669 and April63. I am glad that you guys are so helpful to me. I am not sure why my doctor treated me with hespera first. When I was under treatment, Viread was not approved for HBV according to the doctor. I was on Baraclude for probably 4 months or more and my HBV DNA could not go down any further. Then Viread came and I was on combo. The combo worked well, I guess. There were two tests, one HBV DNA and the other one is viral replication (not sure exactly what)?. Not sure the sensitivity of the test since the lab got switched from one to the other. I have never heard from my doctor that I should be on ntz. I guess so far the combo works fine therefore ntz was not added to my combo. what is tnf and what is etv? my hbe is still positive. April63, I do not believe coffee will be a problem. I do think diarrhea made my drug absorption a problem. Thanks.

[stef2011]

I have never heard from my doctor that I should be on ntz

it is an off label drugs, he will never tell you, very few expert will prescribe

what is tnf and what is etv?
the most potent antivirals available now, only active on hbvdna

[AsianMale]

what is tnf and what is etv?

tnf, or Tenofovir, is marketed under the trade name Viread.
etv, or Entecavir, is marketed under the trade name Baraclude.

So...

tnf = Tenofovir (drug) = Viread (trade name)
etv = Entecavir (drug) = Baraclude (trade name)

[stef2011]

tnf = Tenofovir (drug) = Viread (trade name)          generic: tenvir, tavin
etv = Entecavir (drug) = Baraclude (trade name)    generic:  Entaco, Entehep, X-vir,

[stef2011]

price of drugs india (prices per tablet)
Entehep, X-vir, are priced Rs 82/- and Rs 75/- for 0.5 mg versions Rs 147/- for mg tablets.
Entaco priced at Rs 82/- and Rs 169/- for 0.5 mg and 1 mg tablets respectively.
BMS’ Baraclude, which has been granted protection in India, costs Rs 212/- and Rs 312/- respectively.

1 indian rupee about 0.022USD

[wonderboy2011]

The price of Viread and Baraclude in Nidia is much cheaper. Is there a way to get them from India to the US?

[wonderboy2011]

Hi Stefano,
How do we get Viread and/or Baraclude from India? The price of these two drug in the US is insane. And I feel I could not afford them anymore if my job situation changes. Thanks in advance for the information.

[stef2011]

the only option to get it very low price is to get to an indian pharmacy with a prescription and buy it, although the so good US government may not allow you to get the drugs to US through customs (they just work for drug makers i don t see so much efforts for the peolple...)

the other option is having a friend who ships them by normal post, it is not possible to scan all normal post so if the shipments are small you will receive it

the third option is order from a canadian pharmacy but of course the price will be higher than buying directly in india but at least if the shipment is blocked or unreceived they will resend free, i can send by pm the pharmacies i have found as reliable

to find if a pharmacy is reliable you have to check for address, phone number, real certificate of the pharmacy and online secure pharmacy checker websites.to be 100% sure i ordered the drug and made a chemical check on them for purity to see if it was the real drug

[stef2011]

i have seen that if you get too low income you can have some coverage contacting drug makers directly, i guess it is soemthing like the free medical coverage by obama or similar assistance programms but anyway check also canadian pharmacies if you can save money

[wonderboy2011]

Thanks Stefano. Obama's plan won't help me. I guess I will pay out of my own pocket. Tenefovir seems to be reasonable priced online for $99/30 tablet. I will check Entecavir and Alinia.
I am still on Entecavir and Viread combo, no NTZ yet. Thinking whether if I should change my doctor.

[stef2011]

why are you on combo?did you have resistance mutated strains?if you have no resistance to lam or other drugs tenofovir mono is ok

[lappyjain]

Hello

I am taking Entecavir for 3yr and it has reduced viral load to undetactable.

But for last 2-3 weeks i am having prob of vomitting and dont feel like eating.

So i checked SGPT n SGOT n ALT:-

SGPT:- 52
SGOT:- 42
ALT:-296

So wht can be concluded from this??

Can anyone help ??

I have not stopped medication.

[lappyjain]

Hello

I am taking Entecavir for 3yr and it has reduced viral load to undetactable.

But for last 2-3 weeks i am having prob of vomitting and dont feel like eating.

So i checked SGPT n SGOT n ALT:-

SGPT:- 52
SGOT:- 42
ALT:-296

So wht can be concluded from this??

Can anyone help ??

I have not stopped medication.

[stef2011]

if hbvdna is detactable at 10iu/ml or higher u are resistant to it, combo with tenofovir which is the only hbv drug with no resistance

[AsianMale]

Within 2 months of stopping the use of Viread, I relapsed. Here's a complete history of my situation.

Test Results, Late June 2009:
    HBV DNA ULTRA QNT (or Viral Load): > 200,000,000 IU/mL
    ALT: 294 Units/L   (21-72 is the normal range)
    AST: 112 Units/L   (17-59 is the normal range)
    e-antigen positive, e-antibody negative
    Everything else was normal

Early July 2009:
    Started taking 300mg Viread (Tenofovir) daily

Test Results, Early October 2009 - e-seroconversion
    HBV DNA ULTRA QNT (or Viral Load): Not Detected
    ALT: 43 Units/L   (21-72 is the normal range)
    AST: 21 Units/L   (17-59 is the normal range)
    HEP.BE VIRUS ANTIG: Negative
    HEP.BE VIRUS ANTIB: Positive
    Everything else was normal.

Test Results, Mid Feb 2010
    HBV IU: <40 IU/mL
    HBV DNA ULTRA QNT (or Viral Load): <1.6 log IU
    ALT: 34 Units/L   (21-72 is the normal range)
    AST: 18 Units/L   (17-59 is the normal range)
    HEP.BE VIRUS ANTIG: Negative
    HEP.BE VIRUS ANTIB: Positive
    All else normal.

Test Results, Late October 2010
    HBV IU: Not Quantified
    HBV DNA ULTRA QNT (or Viral Load): No Quantified
    ALT: 38 Units/L   (21-72 is the normal range)
    AST: 25 Units/L   (17-59 is the normal range)
    HEP.BE VIRUS ANTIG: Negative
    HEP.BE VIRUS ANTIB: Positive
    All else normal.

Late December 2010:
    Stopped taking Viread

Test Results, Mid Feb 2011 - RELAPSE
    HBV IU: 1,500 IU/mL
    HBV DNA ULTRA QNT (or Viral Load): 3.2 log IU
    ALT: 30 Units/L   (21-72 is the normal range)
    AST: 22 Units/L   (17-59 is the normal range)
    All else normal.

Late Feb 2011:
    Continued taking Viread

Test Results, mid April 2011:
    HBV IU: Detected, but below 1.3 log IU/mL
    HBV DNA ULTRA QNT (or Viral Load): Detected, but below 1.3 log IU/mL
    ALT: 41 Units/L   (21-72 is the normal range)
    AST: 29 Units/L   (17-59 is the normal range)
    All else normal.


At this point, it's unclear to me where the endpoint to treatment is, besides S-seroconversion. Any further insight would be appreciated.

-AM

[stef2011]

be aware that most doctors are ignorant on hbv, many are crazy in prescriptions of "out of guidelines drugs" that worsen hbv

hbsag negative is the only result, all the rest is useless, even hbvdna undetactable has no meaning in terms of stopping infection, hbvdna undetactable means less replication and less liver damage but the infection goes on

do change doctor right away if he told you to stop antivirals, he is a crazy ignorant, hbeag has no meaning during antivirals therapy.

stopping tenofovir and making hbvdna high you are at very high risk of virus mutations that cannot be treated, i'd make a combination of entecavir+tenofovir or tenofovir+interferon to be sure any mutant can be prevented
be aware that once mutations happen there is very little to do to get rid of them, so it is better to combo when hbvdna cannot be reached very fast by 6 months

[stef2011]

check also latest studied posted about antiviral effect of lowering cholesterol by red yeast rice, lycopene, vitamin b5, liposomal glutathione together with antiviral therapy by nucs or immune modulators like interferons

statin can be used too but i'd avoid them because they might make liver damage in some cases and RYR and lycopene have about the same potency but no sides

[alexromero]

Is there anyone up here?
Im male and 25 years of age im scared about the result of my hbv dna viral load. cn anyone interpret this? is it dangerous? curable? or what.

liver ultrasond---- normal
repeat sgpt and sgot-- normal
HVB DNA----- result-- 110 000 000 iu/ml
HBsAg-- ---reactive

please help! my hbv dna is very high. what does it mean?

[stef2011]

see the other response, it means you are perfectly healthy as long as alt/ast stay normal (normal is below 30)

if you dont have a family history of liver cancer you have nothing to worry about

if you move in other countries make the following additional tests to have 100% perfect monitoring:
hbsag quantity in iu/ml
fibroscan

do not waste money on normal hbsag test which says reactive, hbcab tests because useless for a cronic (chronic) carrier

[jng2301]

Hi all!  My dad is in his 60s; he was recently tested positive for HepB, and he has been on Viread for about 1 month now.  I was researching about Viread when my research led me to this forum.

To all those who have been taking Viread...
1)  Are there any food and non-alcoholic drink that you should avoid eating and drinking while on this medication?

2)  When my dad first took the medication, for the first two weeks, his heart pulse increases by approx. 10 beats more than his regular pulse rate.  Is this normal?  

3)  Also, lately he has been complaining about having shoulder pain.  We're not sure if it's cause by Viread or something else.  Does anyone have this problem while taking Viread?

4) Lastly, are there anything we should monitor or watch out for (beside the kidney) while on Viread?  

I've only beginning to understand about HepB and Viread after my dad was tested positive for HepB.  I'm truly appreciate any advices and guidance anyone could give me.  Thank you in advance for all your help!

J

[April63]

Hi, my husband is on Viread. He's been on it for almost 2 years. I don't know of any food or drinks that should be avoided. Maybe grapefruit? I mean larger amounts. But I'm not sure about it.  My husband has not have any symptoms you are describing. I would have it checked. As far as I know the kidneys are the only organs that are affected by Viread. Lately the doctors were advised to check not only creatinine level but also serum phosphate level in patients taking Viread. Maybe that's what should be checked in your father's case.It affects muscles and heart is a muscle. Best regards.:)

[stef2011]

shoulder pain is common for many cronic (chronic) infections so probably just due to hbv cronic (chronic) infection

viread may affect bone density and kidneys by many years of use so it is suggested to supplement with coq10 and make vitamin d 25OH at least 50ng/ml by supplements, sun or sunbed

if any problem with kidenys show up you may use fibroguard from hepatitistechnologies, i cant use viread because of this and also the combo of entecavir+alinia made a rise on my creatinine from baseline 0.95 to 1.2, fibroguard made it 0.8 or 0.75 (dont remember now) by 4 weeks
fibroguard is also able to reverse liver fibrosis if present, it is better to avoid fibroguard only with interferon while it is ok with antivirals

[kumar301]

History:-
>        Suffering from Hepatitis B with Liver Cirrhosis since 2003
>        Year 2003 HBsAG, HBeAG and HBV DNA were positive.
>        Year 2003 HBeAG became Negative.
>        Year 2005 to till date HBV DNA is Negative
>        Medicine  Limuvir 100 mg taken -From Year 2003 to 2005- taken
>        Medicine  Betaptir 80 mg taken – Year 2003 to till date (2 years)
>        Spleen is 18 cm and Spleen vain is 12cm since year 2003.
>        Since last 2 year pleated count is around 40000 and last 1 year WBC count is 2500 /cmm
Present Condition
Present Condition


HBsAg :23.31 IU/ML

Pleated count :50000

WBC count::2500 cmm

Spleen:17 cm

Spleen vain :14cm

Endoscopy:Grade 1

AFT:3.2

Hbv DNA :31893 IU/ml
It was undedicated since last 8 years. Hbv DNA was 6 IU/ml & Hbv DNA qualitative was negative in February 2011; after 4 month ( 30 July 2011) it is found 31893 IU/ml.
Alt[SGPT]:311ml
It was under normal range since last 8 years .SGTP increased from normal range to  311 in 20 days
Ast[SGOT]:181 ml
It was under normal range since last 8 years. SGOP increased from normal range to 181  in 20 days
HBeAg:Negative (0.511)
It is always negative since 2004.
HBsAb-Ab:Negative -0.6

CT-SCAN Triple Phase (30 July,11)

Findings are suggestive of cirrhosis of liver with portal hypertension.Moderate to severe spenomegaly.No ascitis. Measures 17Cm and Splenic Vein dilated measure14 mm.(Maximum dialmeter)).The same was observed in Ultrasound since 2003.
Heath Summary : Good Appetite, No Weakness, No Bleeding, No Swelling in leg,

No blood in Stool, No fever, Feeling Excess thrust, Weight 62kg. BP 110/75 .

pulse rate- 70,

Hight: 170 cm, BMI: 22.35, Waist: 34 inch


Query:
1. Considering I have taken Limuvir for 2 years (2003- 2005) and I am having Liver Cirrhosis. Which medicine would be safe and good for me to control viral load.
1. In this condition can I do brisk walk and abdomen exercise?  

[stef2011]

Which medicine would be safe and good for me to control viral load.

as answered to the other post only tenofovir left that works

[Danika070707]

Hi how are you? How is your hapitatis B doing? I am a 25 year old female currently taking viread medication for 6months now, I have received some side effected from the medicine that is why I am here to do some research and want to know more information and than I saw your posted, it's make me happy to see I am not alone can I ask how is your treatment doing now ? Which medication did you take viread or baraclude ? How much is your viral load now ? It has been 2 years already since your last posted I hope you will check this post or anyone else know more information about hapitatis B plz give me some advice on how to take care this diease , I am looking forward to hear from u as soon as possible thank u in adavance...  

[Danika070707]

Hi how are you? How is your hapitatis B doing? I am a 25 year old female currently taking viread medication for 6months now, I have received some side effected from the medicine that is why I am here to do some research and want to know more information and than I saw your posted, it's make me happy to see I am not alone can I ask how is your treatment doing now ? Which medication did you take viread or baraclude ? How much is your viral load now ? It has been 2 years already since your last posted I hope you will check this post or anyone else know more information about hapitatis B plz give me some advice on how to take care this diease , I am looking forward to hear from u as soon as possible thank u in adavance...  

[Danika070707]

Hi how are you? How is your hapitatis B doing? I am a 25 year old female currently taking viread medication for 6months now, I have received some side effected from the medicine that is why I am here to do some research and want to know more information and than I saw your posted, it's make me happy to see I am not alone can I ask how is your treatment doing now ? Which medication did you take viread or baraclude ? How much is your viral load now ? It has been 2 years already since your last posted I hope you will check this post or anyone else know more information about hapitatis B plz give me some advice on how to take care this diease , I am looking forward to hear from u as soon as possible thank u in adavance...  

[asianmale1987]

Dears,

I'm 24 asian male and i've run through full medical test on 2011-05-12, then found out that i've had HBV infection.

HBV-DNA(PCR) - 52485 copies/ml.
SGOT - 43 U/L - (8-38 is normal)
SGPT - 64 U/L - (4-44 is normal)
Amylase - 135 U/L - (43-116 normal)
PCT - 0.186%
{DW - 15.8

It seems when I was 2 months old, I've had hard cough and took blood with antibody, at that time I've had infection.

I met with doctor and he suggested me to use baraclude 0.5mg, so i'm taking baraclude for last 19 days.
I will took for 1 month and will take test again. Doctor said if successful I should take baraclude for 2+ years.

[x4hbv]

Hi,

I'm new to the forum. I’m a male in my mid-50's of east Asian decent. I got my HBV through vertical transmission when I was an infant.

Here is my situation:
HBeAg (-)
HBeAb (+)
HBcAb (+)
HBV DNA (Viral Load) is between 100,000 to 150,000 copies/ml
AST & ALT levels are normal
Genotype is B
Fibrosis Score is 0.21
Liver biopsy was normal in 11/07

Should I be treated now? If yes, with Viread or Baraclude?

Thanks for giving your suggestions.

[stef2011]

you are too young to use antivirals, that doctor is crazy or just a entecavir seller.entecavir is absolutely useless on hbv infection it is used only to stop liver damage but from what you posted he prescribed etv without checking if you have liver damage

he pushed you to take a drug, probably useless, even not knowing if you have liver damage!

he made thing very uncorrect etv cant be stopped because you risk severe liver damage now, just check the drugs warnings, the only way to stop safely is interferon combo

these are the steps to see your status:
fibroscan or biopsy to see if your liver has damage and you need antivirals (antivirals are not an hbv cure, they just stop liver damage)

hbsag quantity in iu/ml to see if you have chances to clear hbv on interferon, at your age this is the best treatment.this can be combo with antivirals

hbvdna is almost no meaning on infection but can be used with hbsag to see if drus are working or not, but only hbsag quantity will tell you if you are clearing infection

so in the end i'd sue that doctor or ask what the hell he is doing, your chances to clear hbv on etv are less than 2% since chances without drugs are 3%.and i'd be very very angry because he didn t check your liver damage or if you have chances to clear hbv

with etv treatment hbsag increase (not decrease) on most patients, so chances to clear are even less

[stef2011]

at your age treatment is suggested becaue HCC/cirrhosis risk increase after 40yo and max at around 50yo

Should I be treated now? If yes, with Viread or Baraclude?
you have no liver damage so i would use these antivirals which have 0% chances to clear hbv on hbeag neg.i'd try interferon combos first

check your hbsag quantity in iu/ml so we know the chances of eradication on interferon+alinia+simvastatin+vitamin d3

meanwhile you can start vitamin d3 supplements and check serum level vitd25oh, values higher than 50ng/ml are best

[x4hbv]

Thank you for the valuable information.
I’ll discuss with my doctor and try interferon combos.

[wz5768]

hello All, Can someone help me out here what to do?
I am 26 Yrs old Asian, have HBV, since a child. I went to several doctors from 2010 to 2011. some doctors recommended barraclude and some prefer viread, and some said i can choose either barraclude or viread.

Here's my most recent results.
august 15th. 2011.
HBV as IU/mL >170,000,000
HBV as Copies/mL > 989,400,000

Hepatitis Panel (4)
Hep A Ab, IgM  Negative,
HBsAg Screen  Negative
HBsAg Confirmation   Positive Abnormal
Hep B Core Ab, IgM   Negative
Hep C Virus Ab             <0.1
s/co ratio 0.0-0.9
AFP, Serum, Tumor Marker 3.2
Hep B Surface Ab <0.1
Hep A Ab, Total   Negative


Can someone explain this?

I also did Ultra sound guided to biopsy,
My Biopsy as followed
Liver, needle Biopsy
a. chronic hepatitis with mild activity and no increase in fibrosis
(modified Ishak stage 0/4), compatible with hepatitis B
b. Mild Zone 3 Steatosis
Clinical history
Hepatitis B, thrombocytopenis Cirrhosis

I am currently on Herbal medicine, should i start taking viread or barraclude?

[stef2011]

very bad doctors you are too young for antivirlas, they are a life time therapy with no effect on infection so there is no reason to use antivirals at your age

biopsy says no liver damage but you have fatty liver due to overwheight or bad quality food, too fat/meat.this needs to be changes for liver to stay healthy in both hbv pos or hbv neg people

what is your alt level? you look immune tollerant stage, if it is so what doctors have you found?immune tollerant must not be treated and if so they should be sued for possible damage to your haealth and just pushing drugs sales

[stef2011]

Clinical history
Hepatitis B, thrombocytopenis Cirrhosis

this says you have cirrhosis but then biopsy says no fibrosis, there is something wrong in this report

my suggestion is:
verify if alt are normal and you are immune tollerant, in this case you are prefectly healthy and no treatment must be started because it can worsen your phase of infection now

monitor liver damage every 6-12 months by a fibroscan, this is better than biopsies

check hbsag quantity by abbott architect to verify if you are imune tollerant and if interferon can help clear hbv

[wz5768]

thx for the quick reply

AST  20
ALT  58

the most recent one, but last yr was ranging ALT 90s,
and All my previous test was at 110,000,000, all of a sudden increase to 170,000,000 .

[wz5768]

the doctor said i don't have cirrhoiss , it was during the ultrasound, they were thinking i have cirhoiss, that's the reason they put on medical history. strange.
How do i check if i am immune tolerant?

[stef2011]

alt 58 is probably due to fatty liver which can be more serious than hbv too, so i suggest improve your healthy life style like reduce bmi to less than 24, do not eat red meat or fats, make exsercise

of course i assume you dont use drugs of any type and dont drink alchool because both make much more damage than hbv

if alt lowers than it is not related to hbv and you dont need to treat

[wz5768]

My most recent Diagnosis Date Reported November 15th, 2011
AST(SGOT) 80
ALT(SGPT) 195
Cholesterol 235
Cholestrol/HDL ratio 4.6

Hep B DNA Viral Load >170,000,000 iu/ml
i was taking herbal medicine for 3 months, is this the reason, it boost my ALT . and AST.
I saw another doctor in california,
He told me I should wait for 2-3 weeks, to take another AST and ALT test if it goes down, i don't have to take Viread,
if still remains the same high, I should take, it
or He recommended weather or not i should take it NOW, this is the ideal stage to take Viread when it's active.

Should i Take this right way,?  
i am turning 27 this year . i know it's a life long commitment, the doctor also mentioned, people usally take it in late 30s or early 40s. i am too young to take this pills, but at the ALT level high, i should start taking them.

[stef2011]

try to see very update liver specialists, if you are in LA area i can PM one of the most advanced specialist/researcher

you have a very high viral load, are you hbeag positive?hbv can be clear today in a high percentage so it is very bad that a doctor thinks like it is not possible and also antivirals can be stopped when you like because hbv cure can t be achieved by antivirals only or nterferon only, from last liver meeting we have seen that the cure is  combo of interferon and antivirals done at the right time sequentially

if you are hbeag pos and young you have very high chances to clear, you need to make hbvdna undetactable by tenofovir first and if you see it lowers slowly by tenofovir+entecavir and then once undetactable for some time you add on interferon and follow how hbsag goes down

even if you dont clear by 2-3 years of this combo you can stop antivirals safely if you like and if hbsag becomes lower than 1000-1500iu/ml (if geno a-d) you can even stay off therapy with inactive hbv

problems to make this combo:
insurances, they dont want to cover such expensive combos

doctors, they are not updated or instead of helping patients they help insurances....

as waht said by the doctor: hbvdna and alt have very little meaning to a successful hbv therapy because today we use hbsag quantity which can guide therapy more accurately.....US doesn t allow these tests, to me they try to keep you on long life antivirals to make money and not trying to cure you, you can ship blood samples to check hbsag quant out of US, the rest of the world uses hbsag quant (canada, UK,US and australia are the only ones not using it)

[stef2011]

if you cant combo by interferon because of insurance issues, well then your doctor is right taking antivirals at your age is useless unless you have liver damage but again n US you can t check liver damage because fibroscans, used in the rest of the world since 2004, are not allowed

[wz5768]

yes i am in the LA area, if there a specialist i should go ?
yes when i was checked in August the AST/ALT were normal, and it suddenly boost up in 3 months,
I am HBeAg positive, and Hep Be Antigen Negative
doctors always recommend barraclude or viread, none of them ever mention taking combo, they don't suggest at all. ?


i go to China often, i take probably take quantitive test there. is this necessary? what's the difference?
u saying taking the viread first. when until the viral drops to undetectable level. and taking interferon? i havent heard of interferon, what is it about ?

[stef2011]

hbsag level will tell you if you can clear and if/when add nterferon, check other posters about interferon+nucs combo

doctors in US just put you on antivirals not to cure but for drug makers to make money, this is the main activity in US healthcare..no wonder interferon is not methioned, it is the only cure for hbv at the moment but few clear hbv as interferon monotherapy

i will pm a doctor/researcher you can find in LA he will tell you best strategies to try to clear before hbeag gets negative, at that point clearing becomes very difficult

[wz5768]

i have seen the previous post asianmale,
he's bout the same siutation as me, he took Viread to undetecable level, and HBEAG goes to negative, but he bounces back. after stop taking viread,
so he continued taking it. i was wondering how's he doing now.

[stef2011]

if he doesnt measure hbsag he will never know when he can stop and keep immuno control

geno a-d, immune control hbsag less or equal to 500iu/ml, hbvdna less or equal 2000iu/ml

for b and c hbsag must be lower but dont remember exactly if 100 or 300iu/ml

i bet you ont know your genotype and hbsag, your bcp and precore mutants as well....in LA you are just customers for antivirals not patients to cure

[wz5768]

is there anywhere i can get treated if not united states?
if the hbsag goes reverse to negative doesn't it mean i am cured? but it would bounce back like asianmale did COULD BE SCARY?
after taking Viread, to undetecable level, then should consider taking inteferon combine with viread for a period of time then go out of country take quatitive test ?

[grmr]

hi wz,

me and u are almost in the same condition check my therads out , i hope thi could help... also I'm about to make this choice on combo..

[stef2011]

if hbsag goes down to 500iu/ml it wont get back but only clear

if hbsag goes negative you are cleared

US keeps making confusion and frauding patients by hbvdna which means nothing but only response to antivirals.
hbvdna means nothing to the clearance of infection or the virus, the clearance of the virus it is hbsag negative to mean cearance
so why not test for it?
it is also a stupid and extremely cheap test while hbvdna is very expensive and complicated....there is no excuse this means keeping people sick and paying for antivirals not curing them

[stef2011]

in any case as long as you have good insurance you can do tenofovir and then add interferon to it when/if hbsg goes down

you ll be just missing hbsag quant in US and if you think FDA kept fibroscans away since 2004 they are going to make the same thing to hbsag quant

[wz5768]

Hello grmr,
i am not sure combo is relatively a good idea,
i have consulted with 7, or 8 doctors in the United States, they all recommend one or the other none of them seem to let me take combo .

[wz5768]

Yes, I　ｇｕｅｓｓ　ｉ　ｗｉｌｌ　ｗａｉｔ　ｆｏｒ　２　ｗｅｅｋｓ　ｔｏ　ｔｅｓｔ　ａｇａｉｎ　ｏｎ　ｍｙ　ｅｎｚｙｍｅｓ　ｌｅｖｅｌ．　ａｔ　ｍｅａｎ　ｔｉｍｅ　ｓｔｏｐ　ｔａｋｉｎｇ　ｈｅｒｂ　ｍｅｄｉｃｉｎｅ．　
ｉｆ　ｉｔ　ｒｅｍａｉｎｓ　ｔｈｅ　ｓａｍｅ．　ｉ　ｗｉｌｌ　ｓｔａｒｔ　ｔａｋｉｎｇ　ｔｈｅ　Ｖｉｒｅａｄ　ａｓ　ｐｒｅｓｃｒｉｂｅｄ．　
ｉｆ　ｔｈｅ　ｅｎｚｙｍｅｎ　ｌｅｖｅｌ　ｄｒｏｐｓ　ｉ　ｇｕｅｓｓ　ｉｔ＇ｓ　ｉｎ　ｉｍｍｕｎｅ　ｔｏｌｅｒａｎｔ　ｓｔａｇｅ．　ｓｏ　ｉ　ｗｏｕｌｄｎ＇ｔ　ｂｏｔｈｅｒ　ｔｏ　ｔｏｕｃｈ　ｐｉｌｌｓ．　

ｉ　ｓｈｏｕｌｄ　ａｌｓｏ　ａｓｋ　ａ　ｔｈｅ　ｄｏｃｔｏｒ　ｒｅｇａｒｄｉｎｇ　ｉｎｔｅｆｅｒｏｎ　ａｆｔｅｒ　ｓｔａｒｔｉｎｇ　Ｖｉｒｅａｄ．　Ｓｔｅｆ，　ｄｏ　ｙｏｕ　ｈａｖｅ　ａ　Ｈｉｇｈｌｙ　ｒｅｓｅａｒｃｈｅｒ／ｄｏｃｔｏｒ　ｉｎＬＡ？　　ｃａｎ　ｕ　ｒｅｃｏｍｍｍｅｎｄ　ｔｏ　ｍｅ，　ｇｒｅａｔｌｙ　ａｐｐｒｅｃｉａｔｅｄ．　

[stef2011]

grmr is in italy and we have real doctors not just drug sellers, he is correctly followed at best of hbv knowledge in 2012

in US, all you heard from US doctors is nothing to cure patients, jus try to get the doctor i emailed you, if he is not available and if you move out of US you can try to find a good doctor in europe or china

in Us they dont have the knowledge and the tools to cure hbv, most doctors are just pushed to sell drugs and not cure patients

[stef2011]

i send a PM with the name of best doctor/researcher in LA, check it.but he may be not available because too busy with research, in any case try to contact with him

ast/alt mean nothing to chosse treatment or not, and also hbvdna means nothing, you need to start tdf but only to add interferon when hbvdna is und for some years, tdf alone has only 16% chances to clear hbv after 3 years when hbeag is pos

to see if you are immune tollerant you cant use ast/alt, they are the less important.immune tollerant is found by:
very high hbsag
no liver damage on fibroscan
very high hbvdna
normal ast/alt less than 30

check the PM you are in the best hands of the world if he is available

[calmama]

Can I also have the name of the doc/researcher in LA?  Thank you.

[stef2011]

we dont know if he still visits patients

you can find good liver specialists lists here

http://www.hepb.org/cgi-bin/LiverSpecialistNew.pl

[wz5768]

hello,
after taking Viread, I feel discomfort urinating? is this sort of kidney side effect? is this happened to everyone or just me ?

[stef2011]

did the docotor tell you to check creatinine before and after taking viread?

you need to check creatinine, phosporus, calcium, complete urine test every 4weeks to see if your kidneys were damaged and cant stand viread.
if you have no creatinine before taking viread you need creatinne clearance by 24hrs urine collection, this is the most reliable test because creatinine can be normal in some even with kidneys damage

this is a very rare side effect found only in some with cirrhosis but better check anyway

[action4speed]

Hi All,

I have been through all the comments which are quite informative for me.
Please help me with your knowledge.
I tested my blood in mid 2007 and found that I had contracted HBV with inactive virus but positive HBeAg. The test took place by Elisa method (qualitative) which is now deemed to be obsolete. I did the test three times in four years up to mid 2011 by the same Elisa method which showed inactive virus. But in late 2011 when I tested my blood by quantitative (new method) my viral load was 12000 copies/ml and positive HBeAg. after 4 months it increased to 90000 copies/ml. my doc has just prescribed Tenofovir but i have not started using it.
my liver was shown as normal in ultrasound. I have no other problem in my body but very rarely I feel minor pain inside my chest on both sides.
Please help me with your detailed advice on how to start medication and which medication can be best and what do you guess about the pain?

I appreciate the informative comments to save each other from the fatal disease.

Best Regards,
GRS

[stef2011]

first i d check liver damage as soon as possible, US is useless for this, you need a fibroscan, if result is less than 7kpa (mild fibrosis) you have the choice to wait

second id check hbsag quant in iu/ml and if the level is less than 1500iu/ml i d go on therapy immediately because the chances are you will clear hbv with sequential tdf and interferon

why to wait if you can do sequential therapy with tdf+interferon and clear?if you wait hbeag will get negative sooner or later and chances to clear will be  much much lower.hbeagnegative is due to bcp and precore mutants mainly and hbv gets more aggressive in this form

the hbv cure with 40% clearance is:
1-3 years of tdf with hbvdna totally undetactable
2 years of interferon add on

also look for all posts about simvastatin and vitamin d3, alinia, to boost interferon response.a guy just tried interferon+sim and he is clearing hbv at 12 weeks already

[action4speed]

Dear Stef2011, thanks for the reply.
I would like to request Stef2011, Cajim and Steven NYer and others to kindly go through following test results and let me know your understanding of what is best to do in my case.
I am entering exact information of my test results in the following context. I am not so good in understanding everything within that.

30 Aug 2011:
Viral load = 26000 HBV copies/ml
HBeAg = Non-reactive (cut-off rate:1.00, Patient Rate: 0.34)
Anti HBeAg = Reactive (cut-off rate:1.00, Patient Rate: 0.02)
Anti HDV(total) = Negative (0.29)
HBsAg = Reactive (cut-off rate:1.00, Patient Rate: 1072.29)
Anti HCV = Non-reactive (cut-off rate:1.00, Patient Rate: 0.12)
Anti HIV = Non-reactive (cut-off rate:1.00, Patient Rate: 0.12)

15 Dec 2011:
Viral load = 93100 HBV copies/ml
Anti HBeAg = Reactive (cut-off rate:1.00, Patient Rate: 0.01)
HBeAg = Non-reactive (cut-off rate:1.00, Patient Rate: 0.60)
Anti HDV (total) = Negative (0.349)

I will check for fibroscan and will let you know about it. Waiting for your response before starting my therapy.

Best Regards,

[stef2011]

hbvdna meanless changes
Viral load = 26000 HBV copies/ml
Viral load = 93100 HBV copies/ml

all the rest meanless as regards hbv infection status and possible clearance, if we want to clear hbv we need hbsag quant in iu/ml and then start tenofovir monitoring hbsag quant in iu/ml (hbvdna must be und) after one year und i'd consider interferon add on with possible use of off label use of simvastatin, alinia and vit d3

[djxpress]

I would like an opinion as well.  I am in the USA and they don't have fibroscan here.  I am a 36 y.o. asian-american male, HBV positive since birth.  My lab tests come up with normal ALT/AST.  They don't do quant on HBsAg here in the states.  

2/3/2012
AST 23
ALT 28
Viral DNA 2300 IU
HBeAg - negative
HBeAb - positive
AFP - 3.0
all other liver enzymes within range.  No symptoms.

The ultrasound and MRI came back unremarkable, with normal liver size, density, etc.  Again, no fibroscan can be done here in the states.

My doctor is Robert Gish, a world renowned hepatologist.  He wants me to start Entecavir treatment, which I understand is for life.

Any thoughts?

[stef2011]

it is useless to start entecavir since entecavir can only act on hbvdna and ast/alt, both are already normal (hbvdna very low), so i see no reasons to use antivirals since their use is only to recover liver damage without any effect on hbv

to cure hbv hbsag quant and fibroscan are essential......you can easly understand why US is not using these tests even if the rest of the world is since 2000-2004, without these tests doctors are blind and can only prescribe antivirals even when useless

anyway most cases like yours have very low hbsag which can be cleared by interferon very fast but to know if you can go directly to interferon or better start tenofovir first and then add interferon to clear we need hbsag quant

do you have any way to ship samples to india or china or move to mexico or europe where hbsag is available?FDA approved hbsag quant this year but i dont know if drug makers are so potent there to keep labs not using this stupid test

[stef2011]

another reason to prescribe entecavir can be if you have family history of liver cancer or genotype C, or if you have bcp/precore hbv, in this case use of antivirals can reduce HCC risk

we can also think this way even if we dont know hbsag quant since the choices to cure hbv are the same:

- make sure this doctor is willing to prescribe interferon sequential treatment with interferon add on after antiviral

- if he agrees i d strt on tenofovir which is more potent than entecavir, take it for at least one year
- after one year of hbvdna undetactable interferon add on for at least 96weeks

of course without hbsag quant next year there is no way to know if you are clearing or not so you have to find a way to have this test for 2013

follow the forum to see interferon+alinia+simvastatin and how it boosts interferon hbv clearance

whatever the treatment or even off treatment always take vit d3 supplements and monitor regularly every 3 months both vitd25oh and serum calcium.the target is vit d optimum levels at 50-90ng/ml because they have antiviral, anticancer and antifibrotic effect
to reach serum levels of 50-90ng/ml 5000-10000iu vit d3 are needed, you will find the balance to keep those levels by monitoring

it is also possible that you can get hbvdn to less than 2300iu/ml by vitamin d3, simvasttin and alinia, all no sides drugs but all off label.these wont clear hbv but are safe and can be stopped anytime

also the interferon try is not a forced choice, interferon can be stopped anytime and even tenofofvir or entecavir can be stopped after interferon combo in the unprobable case hbv is not cleared

[djxpress]

Hi stef2011,

To clarify a few things: Yes I am Genotype C and I do have a higher risk for HCC because I had an AFP-L3% test that came back rather high, which indicates my chances of getting HCC are increased.  My MRI and ultrasound came back negative, so maybe I should start Entecavir now to reduce my risk of HCC.  Also, in 2015 Baraclude (Entecavir) will no longer hold a US patent, meaning generics can be made and sold here.

I live 30 minutes away from the Mexico (Tijuana) border.  Maybe someone knows of a good clinic down there where I can have HBsAg tested?

What is the benefit of starting Tenofovir before Interferon, especially since I am HBeAg negative and HBeAb positive?  I read that Entecavir is a better choice for HBeAg negative carriers.

Also, for people who clear the HBsAg and become negative, does that mean they are cured and the HBV is gone from the body, or does it just mean that it is no longer replicating?  Will us chronic carriers always have minimal HBV in our system?

I have an appointment to see Dr. Gish on Tuesday, so I will mention all of your great advice stef2011.  He probably has some insight because he has worked in different countries to combat HBV, and has been recognized in Vietnam for all the work he did.  Hopefully he will be open to the suggestions and not just do what is best for the US drugmakers.

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/Add--on-of-peg-interferon-to-a-stable-nucleoside--hbsag-loss-40/show/1616137

in italy this is already routine and we are getting treated this way, some who started 2011 already cleared hbv.
interferon doesn t clear hbv in all patients because hbv is able to suppress interferon too (not only our immune system), tenofovir and entecavir are able to reverse this pretty fast, in the abstract 3 years, but i believe that also shorter periods can rescue our immune system and gain interferon response.we also have off label vit d3, alinia and simvastatin to boost interferon response

i prefer tenofovir because more potent, cheaper, closer to lose patent and zero resistance risk

I live 30 minutes away from the Mexico (Tijuana) border.  Maybe someone knows of a good clinic down there where I can have HBsAg tested?

i dont know where but you just need to look for abbott architect machine and then for quantification.i guess the machines are in US too because older machines can t detect hbsag mutants and give false negatives but the machines are not being used to quantify hbsag.the cost is the same as for hbsag qualitative

I read that Entecavir is a better choice for HBeAg negative carriers.

this is wrong tenofovir is more potent over all antivirals and over all immune staus, entecavir is just more expensive

in easy words hbsag negative means hbv is gone and can t replicate, hbsab antibody will then increase and protect liver from reinfection

Will us chronic carriers always have minimal HBV in our system?

cronic (chronic) or acute when we clear that's the same.there are rare cases of occult hbv due to hbsag mutations but this can happen both in cronic (chronic) or acute, but on therapy hbsag mutants risk is higher with weaker drugs or with interferon monotherapy

yes just propose sequential treatment with etv or tdf and then interferon just like they are doing in italy and france to many many patients, i can tell you for sure it is becoming routine in italy

[stef2011]

ask him also where to have hbsag in US since FDA just approved it

[djxpress]

My one concern with treatment is that I am worried it may cause me more long term problems than it will solve. For one, I will no longer be considered "naive" to treatment, and future treatments options may not work if I've already started this therapy.

Also, since I am HBeAb positive and HBeAg negative with somewhat low viral load, isn't that considered the normal endpoint for treatment anyways?  

And, Entecavir can cause lactic acidosis, liver damage, and even HCC.  Some of these side effects seem pretty bad.  

Finally, I am worried that if I start antivirals, the medication will "wake up" my somewhat dormant, low viral load HBV and cause it to try to start replicating more, possibly causing weird mutations that are untreatable.

What are your thoughts stef2011?

[stef2011]

My one concern with treatment is that I am worried it may cause me more long term problems than it will solve. For one, I will no longer be considered "naive" to treatment, and future treatments options may not work if I've already started this therapy.

complitely wrong, both tenofovir and interferon have zero resistance, you can stop them if used combo as many times as you like with no difference.note that non response to sequential interferon+nucs was 10% and it was a patient using lam+adv two ridiculous drugs which failed for hiv and used on hbv just to make some money and of course failed on hbv too

after this combo the chances are that you will end up with clearance or such low hbsag which will clear off therapy itself

Also, since I am HBeAb positive and HBeAg negative with somewhat low viral load, isn't that considered the normal endpoint for treatment anyways?  

yes for what your liver specialist proposed, antivirals for life..... but what i am posting here is to clear hbv or to keep it complitely inactive off therapy plus even if you fail it makes no difference from the situation you have now

And, Entecavir can cause lactic acidosis, liver damage, and even HCC.  Some of these side effects seem pretty bad.

only lactic acidosis, not the rest...and only in end stage cirrhosis (end stage cirrhosis mean slow dying people)

Finally, I am worried that if I start antivirals, the medication will "wake up" my somewhat dormant, low viral load HBV and cause it to try to start replicating more, possibly causing weird mutations that are untreatable.

no this will happen if you dont use drugs almost for sure, hbv makes new mutants all the time until it breaks the little immune control you have now.on tenofovir and interferon hbv will have very little to do

i suggest you read more posts you have very little knowledge of hbv, you need to know much more you can just make blind choices and doctors are not so reliable.check here:
http://www.medhelp.org/tags/health_page/3466/Hepatitis/HepB-Introduction--Welcome-Page?hp_id=34

http://www.medhelp.org/tags/health_page/3466/Hepatitis/the-general-book-of-ignorance-about-hepatitis-B?hp_id=1152

[djxpress]

stef2011,

that is funny, your second link to the General Book of Ignorance was done by the doctor that I am going back to see on Tuesday.  I have a mixed message, should I trust him, or should I try to figure out on my own?

[stef2011]

you can trust him, just tell him if he agrees to sequential combo treatment entecavir+interferon or tenofovir+interferon, interferon add on will be in 1-2 years so plently of time before that

[djxpress]

Do you have a link to the source for FDA approval of HBsAg Quant?  

I posted the info below to the HBV mail-list, for anyone to read:

Hello all,

I just got back from my visit with Dr. Gish.  I am going to start taking Viread (Tenofovir) today in order to reduce my risk for HCC. I am HBsAg negative and HBsAb positive, so I thought I was supposed to take Baraclude (Entecavir), but Dr. Gish recommended Tenofovir because it has 0% resistance, is going off patent in 2014, and has little (if any) side-effects.  He said we just had to monitor my kidneys as 1% of patients who take this drug have kidney issues.  I asked him about bone loss, and he said there is a very low probability of that, and to counteract any bone loss, start taking vitamin D3, which I already take.  

I also asked him about the new study on statins reducing HCC risk, and he said that was indeed possible, especially if you have an elevated triglyceride level.  But he said it would also reduce cancers in other areas as well.  He referred to the same study that I saw on this mail list from a few days ago.

I asked him about the HBsAg Quant test being available in the USA, and he said he's been pushing for that for years (along with the Fibroscan).  He said that info is very useful, and the USA is so far behind the curve when it comes to HBV treatment.  Dr. Gish told me that I may be included in one of his upcoming studies that he is going to be doing with some sort of company (drug company?), and in return for giving some blood, he will be able to get me my HBsAg Quant information from that company, which will be very useful for him.

He also let me know about a clinical trial that may be coming up with Gilead.  He said they are developing a drug for people who are on Tenofovir or Entecavir, which they can take that will enable them to stop having to take these drugs for life.  It sounded like the new drug would have to be taken very short term and then it could be stopped.  Not much info on this yet, but maybe someone else has heard of this trial?

Finally, I asked him about the therapy they are doing in most of Europe where people take Tenofovir for 48 weeks, then they include a Peg-Interferon (info from stef2011), with approximately 40% of patients clearing the surface anitgen.  He said that therapy did work pretty well, and a lot of people cleared the virus for good.  However, he told me to keep in mind, that regimen and the reports examined Caucasians who were chronically infected later in life, so the results may not translate to Asians who were infected from birth.

All-in-all, a very informative visit, with a lot of new information and new possibilities in the pipeline.

Matt

[djxpress]

** correction **
I am HBsAg + and HBsAb-, HBeAg -, and HBeAb +, which was the driving decision to treat.

[4est]

new drug from Gileard will be use like the exit point for Tnf Ent or ?  ... I don't quite understand what is the porous of this new drug

[djxpress]

From what Dr. Gish told me, it seems like Gilead is developing a new drug that would be the endpoint of therapy.  You would take this new drug, replacing Tenofovir or Entecavir (I think), but you wouldn't have to take it for the rest of your life, you'd be able to eventually quit taking all the antiviral medications.

[4est]

that means that Gilead is targeting s seroconversion with this new drug ?

I don't quite understand he relation of this new drug and Tnf and Ent.

[stef2011]

it is the drug presented latelt and used on monkeys for now, it is a trl7 activator and lowers hbsag, maybe dr gish has more info than that presented at conferences.
it is indeed more potent than interferon and if possible i d jump in that study immediately keeping in mind about safety data since we only had results on monkeys which are wuite close to us but not exactly us.on them hbsag just lowered and not cleared but the study was very short and used mono, so this maybe be hbv cure, i do think gilead was scared of rep9ac and myracludex and so they got out the drawer old stuff plus their patent is about to go....in the end they can make much more money with this trl7 activator than from unpatented tenoffovir because they will get anybody hbv positive to use this new drug while most hbvers dont use tenofofvir

[calmama]

If it is GS 9620, then they have some safety data in humans.

http://www.hivandhepatitis.com/2011_conference/easl2011/docs/0412_2010_d.html

' GS-9620 in Humans

Finally, U. Lopatin and colleagues tested the safety, pharmacokinetics, and pharmacodynamics of GS-9620 in human volunteers without viral hepatitis.

This double-blind placebo-controlled study included 75 healthy volunteers. A majority were men and white, and the average age was about 30 years. Participants received single ascending doses of 0.3, 1, 2, 4, 6, 8, and 12 mg GS-9620; 7 cohorts took the drug on an empty stomach and 3 cohorts took it with food.

GS-9620 was generally safe and well tolerated with single doses through 12 mg. The most common adverse events were headaches, chills, and fever. There were no serious adverse events or discontinuations due to adverse events or laboratory abnormalities. A total of 49 treatment-emergent events in 15 people were judged to be drug-related. The number of adverse events increased with higher doses, from 1 per cohort with 2, 4, or 6 mg, to 11 with 8 mg and 31 with 12 mg. Some participants experienced mild platelet decreases, but these changes were "not notable enough to be considered adverse events," according to the researchers.

GS-9620 treatment led to dose-dependent increases in various cytokines, chemokines, and interferon-stimulated genes. Systemic interferon changes were only seen with the 12mg dose. Volunteers receiving the 8 mg and 12 mg doses experienced increases in percentages of activated T-cells, B-cells, and NK cells.

"GS-9620 is a potent, oral small molecule agonist of TLR7, which was safe and well tolerated in single ascending doses up to 12 mg [by mouth," the investigators concluded.

"These findings confirm the preclinical data suggesting that GS-9620 induces multiple cytokines (including Interferon) pre-systemically, with the potential for decreased adverse events compared to systemic pegylated interferon," they continued. "GS-9620 is a promising, oral immunomodulatory agent with potency in the low milligram range and a therapeutic window which supports further evaluation in the therapy of viral hepatitis B and C."'