Hepatitis B Community
Chronic hepatitis B
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Chronic hepatitis B

65 y.o. female, found positive for Hepatitis B in 1998. Her first LFT shown
AST (41/41), ALT 36/45. ordered by my primary care MD:

HB E Antibody POSITIVE, HB E Antigen negative, HB SAg (surface antigen) POSITIVE, HB Surface Antibody Negative
Hep A negative, Hep C negative

In Oct 11, 2000 under care of GI/hepatologist, LFT gave:
AST 399/36, ALT 583/39.
In Nov 06, 2000
HBV DNA Quantitative gave  HBV DNA 24200 copies/mL
HBV DNA (pg/mL)  0.085 pg/mL
Lamuvidine was mentioned but not started due to the fact that HBV DNA viral load less than 50000-100000 copies/mL

In Jan 12, 2001, LFT gave:
AST 26/36, ALT 21/39

In Dec 12, 2002 LFT gave:
AST 50/31, ALT 81/30.
US liver, all other test (EGD, Colonoscopy, MRI) normal.

In Jan 10, 2003
AST 32/30, ALT 34/30

In Jan 25, 2006
HBV DNA viral load 719 copies/mL
In Feb 09 2006
HBV DNA 3770 copies/mL
alpha-fetoprotein 6.7 IU/mL (limit 0-15 IU/mL)
In 2007: US liver, other tests: NORMAL

Recently  In June  07 2010 LFT gave:
AST 31/49
ALT 28/55
Alpha-fetoprotein 2.3 ng (limit 0-8.3) by Roche Eclia method
In June 22 2010, labs gave:
HBV Real-time PCR Quant :  HBV 7650 IU/mL
HBV DNA 44500 copies/mL (1 IU= 5.82 copies)
G.I specialist wants to put on VIREAD 300 mg once daily.
Ultra sound liver on June 29 2010 is normal
Hepatitis C and A negative


Since HBV DNA viral load is 44,500 copies which is still under the limitation to treat (< 50,000-100,000 copies/mL).
Should she hold and have another vival load count in December before making decision?
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33 Comments Post a Comment
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Avatar_m_tn

there is no fibroscan or biopsy to check liver damage, his is the most important since cirrhosis and liver cancer risk increase with age and virus mutations, plus it looks like she is still hbe positive which is more correlated with both cirrhosis and HCC.ultrasound can only see HCC but not early cirrhosis (only advanced cirrhosis with nodules and nodules are dangerous for hcc development)

guidelines, at least euro guidelines which are updated more than yearly (US guidelines abolete not updated since 2008) consider hbvdna>2000iu/ml, alt>19, and liver damage higher than f2 for treatment

if she never had kidneys problems i'd start tenofovir right away since her age and quantity of virus even if liver dmage is f1, this is for cirrhosis prevention and hcc prevention since risk is very high after 40yo

by the way copies/ml is not used anymore because confusing, the WHO standard is iu/ml from many years, to change to iu/ml you have to multiply for 5.8
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Avatar_m_tn

also entecavir might be a good choice since it has no sides but there is 1,2% possibility of resistance, so entecavir can be used safely only after a virus mutation test has been made

tenofovir can have sides of decreased mineral bone density and kidneys, but these sides are very low rate less than 1% so only having hosteoporosis or kidneys problems might be an issue, on the other hand tenofovir has 0% resistance mutations so safer than etv
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Avatar_f_tn
Thank you for the feeback.

The reason for posponing/hesitating because her hbe antigen negative she would have to take tenofovir for life.

She will talk to her specialist in December and will decide to start then.
by the way, do you have any update statistic shown the sides effects of tenofovir.


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Avatar_m_tn
The reason for posponing/hesitating because her hbe antigen negative she would have to take tenofovir for life.

all antiviral except immune modulators are for life, changing to hbe negative has no longer any meaning, it just mean lower replication.the real tests to know if you are inactive and don t need treatment are:
hbsag quantity in iu/ml, reflects immune control, number of infected cells, cccdna value
hbvdna lower than 2000iu/ml with hbsag lower than 1500iu/ml or 500 iu/ml, alt lower 30 men and 19 women, this is real inactive carrier without need of therapy and immune control of hbv all other data is old and wrong

tenofovir and entecavir are not for life after 10-15 years with hbvdna und the cccdna and hbsag will get very low negative.Also the new therapies will be continuous tenofovir or entecavir and staggered interferon therapy to reduce hbsag faster and make it negative before 10-15 years

it is not yet possible to know how many will respond to this regimen

tenofovir and entecavir have no sides practically since sides are on less than 1% patients that s to say among drugs with fewest sides ever.doctors were afarid of sides because there wasnt enough use of these drug but now we are almost at 6-7 years on etv and more than 10 years on tenofovir for hiv patients

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Avatar_f_tn
Appreciate your input, it is very helpful

hbsag quantity in iu/ml, reflects immune control, number of infected cells, cccdna value
hbvdna lower than 2000iu/ml with hbsag lower than 1500iu/ml or 500 iu/ml, alt lower 30 men and 19 women, this is real inactive carrier without need of therapy and immune control of hbv all other data is old and wrong

The last update from aaslg.org (2009) is pretty much on hbvdna and alt for female

Not sure that the hbsag quantity in iu/ml is available here (USA)
But to have fibroscan or biopsy to check liver damage is a must.

Thanks for the update on tenofovir, did not realize that the drug has been on the market that long (USA  marketing is far behind Europe general speaking..)

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Avatar_m_tn
USA  marketing is far behind Europe general speaking..

it is just that drugs makers in US have much more control on the market with insurance companies but if hbvdna is well suppressed you will get rid of hbv even if very long time is required.

hbsag quantity test is so important because that's the only test which can tell you if you are getting rid of the virus and gaining immune control, it is also necessary if one wants to try nitazoxanide since it is active on hbsag only in the first 6-12 months.
Without this test you are not able to know what is happening because hbvdna tests are not sensitive at all to say if virus is lowering in the liver

at the research center hospital where i go they have cccdna test from mononuclear cells in the blood for the trials tests, i have also found labs in asia with these tests available, these will be the more sensitive because all hbv infection persist thanks to cccdna

US looks the worst but i think this is to make all market easier to control
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Avatar_f_tn
Thanks again stefano170669 and very much appreciate your prompt reply. as a matter of fact, the hbsag quantit. ordered from the beginning but the clerk typed in error into screenning, so test will be done again.

Will let you know in a couple of week.

Truly,
AF
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Avatar_m_tn
My test results reads
hbsag positive
hbsab negative
hbsag value 591
hbe negative
hbeab positive
hbvdna undetected
viral load undetected

My doctor says I'm inactive carrier, can stay like that forever. Can I start taking Nitazoxanida and where can I find it. I am in Ghana, Africa
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Avatar_m_tn
hbsag value 591

is the number 591iu/ml?if so you can eradicate hbsag by nitazoxanide very fast, i have sent you a private message where to buy nizonide500 (nitazoxanide)

please let us know how long it takes to make hbsag negative or lower it, follow our threads about how ro take and dose of ntz
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Avatar_m_tn
Thanks so much for the quick response.
Yes, the numbers 591iu/ml.

I thought I could even get one here in Ghana.
Am I active or inactive carrier, also am I infectious

Thank so much
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Avatar_m_tn
One more thing, a doctor prescribed Forever Bee Pollen for which I have started taking, upon research I found out that, it takes care of so many ailment, it boost the immune system to fight against infectious disease like Hep b. You know importing Alinia from US to Ghana-Africa is very costly unless you have someone who can other in bulk quantities. I heard of Milk Thistle is that too easily available?

Thanks so much. Waiting for your response
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Avatar_m_tn

you are slowly clearing the virus and totally inactive, ntz might clear hbsag in a very short time at 1,5 or 2g dose
a member of our group with hbsag 800iu/ml made hbsab antibody in the first month, if you try nitazoxanide use the high dose 1.5g or 2g and let us know if you make hbsab antibody in a couple of months
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Avatar_m_tn
do not waste time on bee things, try to get generic nizonide500 and you might add vitamin d 5000iu daily, vitamin d is an immune modulator that might help ntz

check vit d (25OH) levels after 3-4months, the optimum level is 50-60ng/ml and maximum level 100ng/ml.
in case you have a history of kidneys stones or kidneys illness check also creatinine and calcium because vit D might increase calcium absorption over normal levels and too much calcium damages kidneys, this is almost impossible with only 500iu daily but better check anyway
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Avatar_m_tn
i am surprised you have hbsag quantification in ghana while US, canada and UK don t, their healthcare systems for hbv look like the worst in the world...
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Avatar_m_tn

please do not miss to update the community on ntz result if you choose to use it
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Avatar_m_tn
Forever Bee Pollen, the said to be Healthcare Supplement:  

On Internet I found many articles describing its functions.  Most of them are advertisement.  But I can't find a medical report with scientific proof on its function in curing chronic Hep B.  Could any folk on this forum pointing me the URL in this respect?  TIA

B.R.
satimis
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Avatar_m_tn
Thanks so much for the relieve given me.
Actually the lab where I took my test is
a subsidiary lab from South Africa, they
are more advanced in such things. The
lab here acts as collection point of such
cases and sent to the main lab in South
Africa and you get the results in a week
time. They call it Hepatitis B Profiling
and they use Roche Taqman Assay.
They did LFT, HBV & DNA Viral Loads
and the HB Profiling on me.

I have just called my doctor to check if
he can get me the Nizonide500. Can I have
some from Italy? I have a friend there who
can help.

Your response is greatly anticipated.
Thank you.  
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Avatar_m_tn

the producer is lupin from india, you can order from canadian pharmacies but maybe you will find it in your country or southafrica too since it was approved as an anti-diarrea active on rotavirus and parassites/bacteria which are common in your country and south africa

they did not submit approval in europe since rotavirus or parassites are rare here so it is not marketed in europe, in italy you can have it only inside hospitals
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Avatar_m_tn
using nizonide500 the most important test is hbsag quantity in iu/ml, hbvdna and alt/ast are less important
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Avatar_m_tn
Thank you
I'm waiting for my doctor if he can find me some
then I see the way forward.
How long should I take it before I go for the test.
Is there any side effects?
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Avatar_m_tn

mild diarrea (diarrhea) like when you take antibiotics, if you take probiotics you avoid it, most of us have had a mild diarrea (diarrhea) once that resolved in 2-3 days

How long should I take it before I go for the test.
i'd test after 4-8-12 weeks if you can afford the tests otherwise directly after 6 months, hbsg kinetics are very slow, also check hbsab one in the ntz group with hbsag 800iu/ml made antibody at 200miu/ml in one month but a the third month antibody disappered, he was on the low dose 1g daily and this low dose was not effective on nobody until now
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Avatar_m_tn
Thanks so much for the response.
You have been of immense help to me.
God bless you.

If I understand you well, it means this
medicine can total eradicate Hepatitis B
at this stage of my. If I may know, when I
get hbsab antibody means I'm cured from
hepatitis b.
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Avatar_m_tn
yes hbsab will make hbsag negative within 6 months, there are very rare mutants but they are very rare and ntz is active on all mutants
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Avatar_m_tn
Thank you
I will definitely get back to you
when I start the medication.

Stay blessed
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Avatar_m_tn
One more thing please,
After been declared hbsag negative
can you be then receive vaccination?

Thank you
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Avatar_m_tn

can you be then receive vaccination?

if hbsab is present vaccine is useless since you already have the antibodies, it might be useful if you make hbsag negative but no hbsab antibodies
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Avatar_m_tn
why did your friend who attained hbsag negative and hbsab positive went back to hbsab negative, did he/she stopped taking the piles before 6 months?
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Avatar_m_tn

he is a member of ntz group from china and made several mistakes according to me:
he was on etv and got hbe negative and low hbsag by about 1-2years, he might have lose hbsag with etv only since he reached 800iu/ml which is quite low

he discontinued etv, i think because too expensive i don t remember, and switched to adefovir which is very weak compared to etv.first of all it is not possible to switch directly from a drug to another because every antiviral needs about 1 month to reach good level in the cells.

so his hbsag went from 800iu/ml to 1200iu/ml, alt went from 11 to 31, hbvdna is not possible to know because sensitivity of test was 1000copies/ml it couldnt measure below this.so probably hbv relapsed because adv is not potent enough and might even make mutants in the long term

when he added ntz hbsab appeared in a high number about 220 or 250miu/ml.
he could not buy probiotics to use ntz at 1,5 or 2g because he had stomach disconfort

so the mistakes were:
1 switch directly to adv which is auseless drug for hbv
2 ntz at 1g dose, too low to have an immediate effect

acctualy i do prefer to have a lot of diarrea (diarrhea) with 2.7g daily dose of ntz if i see such a high rise in hbsab....anyway he should have kept adv+etv+ntz 2g or get back to etv+ntz 2g.

all this happened because tenofovir is not marketed yet in china and etv is too expensive but if one is smart he would buy from india entecavir or tenofovir generic too, he was already buying ntz generic from there
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Avatar_m_tn
Goodmorning Stef,
Thanks for the information.
So I guess in my case ntz 2g
daily will be enough for 6 months.
Is ntz expensive as etv?
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Avatar_m_tn

brand alinia from romark is even more expensive, 4 pills a day is about 3500-4000usd per month, the generic nizonide500 is  207usd for 180pills, there are even cheaper prices for nizonide500 around that the chinese forum uses but i don t know if they are reliable

start with 1,5g and probiotics and then increase to 2g always taking probiotics then slowly discontniue probiotics and check if any diarrea (diarrhea) happens, every person has a difference tollerance, i cannot tollerate 2g without probiotics while my sister can tollerate 2g and probably even 2,5g without probiotics
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Avatar_m_tn
wow!!!! really expensive.
What type of drugs are probiotics,
and how long should I take it.
How is the situation about the guy
from China, your own and that of
your sister.

Thanks
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Avatar_m_tn
What type of drugs are probiotics,
and how long should I take it.

when you take antibiotics good doctors always prescribe probiotics, they are healthy bacteria like in the yogurt because antibiotics kill your bacteria too

if you find none of those in your country you might take yogurt too but enterogermina or reuflor (bacillus reuteri) are much more potent, of course probiotics have no sides and maximum dose, in case you find reuflor 2 pills a day are good enough
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Avatar_m_tn
Thanks so much.
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