Chronic hepatitis B

[asiafem722]

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?

[stef2011]

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

[Jojo997]

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

[asiafem722]

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

[stef2011]

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

[asiafem722]

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..)

[stef2011]

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