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Brother Done Liver Transplant and I am NEXT???
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Brother Done Liver Transplant and I am NEXT???

Hi,

My name is Ken and I am of Asian ethnic living in Asian country and am a chronic Hepatitis B and probably was infected since childhood.

Most (if not all) of my family member are also infected with Hepatitis B and one of my brother has done a liver transplant for 3 years with good result. I believe he has seroconvert his HBs from HBsAg postive into NEGATIVE and his AntiHBs from Negative to REACTIVE. In fact, he is in much better shape than myself in term of physical appearance and blood test results.


My latest blood test which is done last week showed:

AST/SGOT >>> 67 (0-40 U/L)
ALT/SGPT >>> 101 (3-40 U/L)

AFP >>>>>>>>7.9 (0.0-15.0 ug/L)

Anti-HAV Total >> REACTIVE
HBsAg >>>>>>>> REACTIVE
Anti-HBs >>>>>>> REACTIVE
Anti-HBs Count >> 20.7 mlU/mL
HBeAg >>>>>>>> REACTIVE
Anti-HBe >>>>>>> NON REACTIVE

My doctor prescribe a 3 months Viread 300mg daily to be taken after food in the morning.

Should I combo this with Interferon to achieve maximum result?

Please help...

Thank you....


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Avatar_m_tn
If you really want to understand the mystery of simultaneous HBsAg/Ab, I refer you to this link:
The Enigma of Concurrent Hepatitis B Surface Antigen (HBsAg) and Antibodies to HBsAg
    Wolfram H. Gerlich⇓
http://cid.oxfordjournals.org/content/44/9/1170.full
23 Comments Post a Comment
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Avatar_m_tn
I am so sorry I forgot to mention that I am now 40 years old and my brother is 48 years old.

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Avatar_m_tn
Good to know your brother is doing well. You have given us very little information in order to give our opinions. All we know is that:
Your are 40
HbsAg positive
HBsAb positive 20.7 miu/ml - above the protective limit, significance unknown (to me)
HBeAg positive
HBeAb negative
ALT is 101 - elevated

It would be nice to also know your viral load (hbvdna), and past history of test results and treatments (if any). Why did your brother have a transplant?

Generally, your are 40, your ALT is elevated and if your hbvdna is also elevated, I would seriously consider treatment, because most likely you will have some degree of fibrosis if you were infected at birth. A biopsy would also be useful, especially if you want to try Interferon.

I am not a doctor, just my opinion.
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Avatar_m_tn
Hi Stephen (if I may call you Stephen),

Thank you for the prompt response.

My brother had a Liver Transplant because his liver was severely damaged by cirrhosis and had several large cancer cells developed. If I am not mistaken, his liver has only less than 20% of good tissues. His Hepatitis B virus is now confirmed cleared by the doctors after the transplantation.

And yes there are limited information that I could give since the doctor only tested those tests above. I will try my best to go to lab tomorrow and have those viral load (HBVDNA) test done.

As I am infected since childhood (not sure if I was infected at birth), I have regularly tested those LFT regularly and only this time those are elevated.

What confused me is why I have HBsAb to be REACTIVE since my lab history has always been Non Reactive. May this mean something? I hope this would mean that my body is now fighting the virus and some are winning.

If that is the case, is it wise for me (and the doctor) to prescribe Viread?

I forgot to mention that I have never taken any drugs or medication to treat my Hepatitis B virus.

Liver biopsy is not possible in where I live (if they can do it, I wouldn't want to do it here either). That means I have to go overseas (Singapore) to have it done. So, if I should do combo with Pegasys, is it not wise without have a Liver biopsys before? Do you recommend doing the combo or just the Viread mono?



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Avatar_m_tn
It is not uncommon to have both HbsAg and HBsAb positive, the cause is unknown. It is good that you have regular monitoring of your ALT. If you don't want to do a biopsy locally, you may consider doing a Fibroscan locally or in Singapore. During PegIfn treatment, an ALT flare can occur which may lead to decompensation IF you have compensated cirrhosis. Generally PEGIFN treatment is preferred if you are a suitable candidate and have good support from your doctor as there can be side effects.An experienced and skilled liver doctor may also be able to guide your PegIFN treament using quantitative HBsAg levels. As for combo of NUC + PegINFN, there is no standard combo and results vary. You may like to get an opinion in Singapore.
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Avatar_m_tn
Dear Stephen,

Alas, the Fibroscan is also not a good idea locally. That means I have to re-visit my doctor in Singapore soon... :(

I have been following several thread in here and others through the web and have never recalled anyone with HBsAg and HBsAb both are positive (REACTIVE) like in my case.

Thank you again for your recommendation and I shall discuss this with my doctor soon.

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Avatar_m_tn
If you really want to understand the mystery of simultaneous HBsAg/Ab, I refer you to this link:
The Enigma of Concurrent Hepatitis B Surface Antigen (HBsAg) and Antibodies to HBsAg
    Wolfram H. Gerlich⇓
http://cid.oxfordjournals.org/content/44/9/1170.full
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Avatar_m_tn
Thank you... That seems to be a good reading but alas, I need to go out now. Will read that article as soon as I returned home.

Thank you again...

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Avatar_m_tn
Hi all,

I have just received my latest test result:

AST/SGOT >>> 87 U/L
ALT/SGPT >>> 139  U/L

AFP >>>>>>>> 10 ng/L

HBsAg >>>>>>>> REACTIVE
HBsAg Quantitative >>> 112.65 IU/mL
Anti-HBs >>>>>>> REACTIVE
Anti-HBs Count >> 21.67 mlU/mL

HBeAg >>>>>>>> REACTIVE
Anti-HBe >>>>>>> NON REACTIVE

HBV-DNA (PCR) >>> 1.01x10^7 IU/L

Note: This latest result is from different lab than the previous results.

QUESTIONS:

1. Is my HBsAg Quantitative result a very high amount?
2. How about my HBV-DNA? How do we interpret it?
3. I have just started VIREAD 300mg daily. Is it recommended?
4. Should I really combo with PEGASYS?
5. Am I in a very dangerous zone?


Please help as I have no any good sleep these last few days thinking about my condition.... :(

Thank you in advance....
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Avatar_m_tn
1. Is my HBsAg Quantitative result a very high amount?

since you have a mutated hbsag we dont know because it has not been studied statistically.a researcher told me that your form is weaker and that they had better response than usual from pegintf.
i think the quantitative may be masked by the mutants, we should know if the test is able to detect and count both normal hbsag and its mutants presnet in ur blood

2. How about my HBV-DNA? How do we interpret it?
high but asians have hi hbvdna usually, to brig it down fast better combo tdf+etv and once hbvdna und continue with tdf mono

3. I have just started VIREAD 300mg daily. Is it recommended?
yes it is the best, if hbvdna declines slow in 4-8weeks you may add etv to get a faster response

4. Should I really combo with PEGASYS?
yes but give antiviral at least one year after hbvdna is und, 3 years best

5. Am I in a very dangerous zone?
only fibroscan can tell or a proper biopsy (biopsy can fail so i suggest fibroscan)
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Avatar_m_tn
Thank you Stef2011 for your prompt response.

In conclusion, I should:

- Continue VIREAD
- Wait till 1 year and preferable my HBV-DNA is UNDETECTED than add on PEGASYS
- Do a Fibroscan soon

Are those correct? Any other important things I should/shouldn't do???

Questions:

- Should I take VIREAD after breakfast or after dinner? I am now taking it after breakfast but my breakfast is so close to lunch (if not miss it because I wake up late). Is it okay to change it to after dinner?

- How long should I combo with Pegasys if I decide to add Pegasys after 1 year of VIREAD?

- Which part of our body should we inject PegInter (Pegasys)??? Can it be injected to our arm or other preferable (recommended) part such as belly or buttock??? I ask this because there is a chance that I will inject this Pegasys myself since I travel a lot and do not like to depend on the nurse in hospital.

Thank you so much and really happy to see you response to my stupid questions...

GOD bless you...

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Avatar_m_tn
I'm not a doctor but I think you should take Viread before bed (before 10 at night). Because the body does maintenance from 9-5 in the morning. Oh and healthy lifestyle is a must, waking up late is bad for health.

You should combo Viread and Pegasys for 1-2 years, if results are good, then combo it until HbsAg -. But 99% of doctors won't do this, they will follow procedures. There's a user called AsianMale1985, see his case.

There's a video on youtube about Pegasys injection. Check it out.
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Avatar_m_tn

absolutely do not take viread before bed, viread must be taken with meals for absorption.

it is entecavir to need empty stomch 2hr before taking the pill and 2 hrs after (4hrs total), so for entecavir it is best to take it before bed
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Avatar_m_tn
really?
the instructions I got for viread is that it does not matter whether you take it with or without food.
i take it before I go to bed.
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Avatar_m_tn

we have posted many times about absorption and it may not be reported both for tenofovir and entecavir because it is commercially bad to report info like that, they might lose customers......

the drugs work anyway but the quantity of drug reaching blood/cells is lower, much lower especially for etv

for etv they just indicated to stay away from food for those with lamivudine resistance and this indication is even useless, entecavir doesn t work on lam resistance patients because it reaches sky high resistance for etv too and must not be used in these cases.
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Avatar_m_tn
still wondering how 42yo and still EAG+ve..
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Avatar_m_tn

our genotype D is mainly hbeag neg before 20yo, the other genotypes and especially asians patients are different and can be hbeag pos all life
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Avatar_m_tn
so wondering which geno i have...
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Avatar_m_tn
then in this case it's strane hbs+ and hbsab+...
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Avatar_m_tn
europe geno A and D, italy mainly D
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Avatar_m_tn

mmhhh you did pegintf without testing your genotype?and bcp/pc mutations?

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Avatar_m_tn
i remember i di bcp/pc.. i do not remeber the result..
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Avatar_m_tn
is it also possibile you develop hbsab antibodies after liver transplant?? this is a query I've had benn always wondering.. if you get a liver with no virus in cccdna theoritcially your immune system would develop antibodies...
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Avatar_m_tn
some develop low titer because they are under immune suppressive therapy

two liver transplant in italy used monthly hbv vaccines and low dose immune suppressive drugs, most developped hbsab and could avoid Hbig infusions/injections.

in any case i d stay on the safe side on transplanted patients and keep the hbig+nucs therapy, being immune suppressed is too dangerous even if they develop high titer hbsab.in that situation immune system can get damaged and suppressed to easily and hbsab go very low or und
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