Combo Treatment: Baraclude + Viread (results)

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 in November. 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 a 23 year old Asian male and found out I had chronic HepB.

---------------------------------------------------DATA---------------------------------------------------
• 1st blood results were (taken in 07/18/2008). NOT ON TREATMENT
HEPATITIS B VIRAL DNA, QUANT PCR             1,630,000,000 H    <160 copies/mL

• 2nd blood results were (taken in 08/19/2008). NOT ON TREATMENT
HEP B VIRAL DNA QT                                      1,020,000,000 H     <160 copies/mL
                                                *some fluctuation in numbers, but still very high

         ♦I started the combo drugs sometime in November with the high DNA count above, if not more.

• 3rd blood results were (taken in December 2008): ON TREATMENT
HEP B VIRAL DNA QT                                      300,000 H     <160 copies/mL

• 4th blood results were (taken in January 2009): ON TREATMENT
HEP B VIRAL DNA QT                                      801 H    <160 copies/mL

• 5th blood results were (taken in April 2009): ON TREATMENT
HEP B VIRAL DNA QT                                      201 H     <160 copies/mL

My doctor said the goal is to get my HepBeAG to turn negative as it is the engine behind the whole process, and the viral count to Zero.

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! Will keep everyone up to date!

[hepbinme]

My ALT and AST according to my FIRST (7/18/08) test results are:

ALT(sgpt)      83 H
AST(sgot)     38

I will try to get my hands on my recent Jan/April 09 results this weekend.

[bberry]

you look good so far.

viral load is considered by some UND . it can still go lower but you're good now

yes the ultimate immediate goal is whatg your doctor told you, the idea is to seroconvert from e antigen positive to negative.. once you reach that goal i believe your doctor will keep you on meds for another period of time 6-12 months and then take you off of meds and have you monitored periodically every 3-6 months

ALT is high obviously, but maybe with your new results it is within range now..

let us know how you feel

good luck

[stevenNYer]

Your lab trends look good.  You should be UND by now.  Since you are only 23, it may take some time for you to "e" seroconvert, could be several years.  So be prepare to see your eAntigen stay positive for some time since there is still too much cccDNA taking hold in your liver cells producing too much eAntigen despite UND DNA.

What's the plan after you go UND?

What is the goal of the study?

[cajim]

Thank you for posting and sharing your lab results.

Recently I discussed Hep B and its various lab readings with a Western medicine trained hepatologist according to whom unlike the assumption of many patients with HBV, particularly new patients, that high HBV DNA is horrible and is what is killing the liver cells, what hurts and damages liver cells in patients with HBV is the human immune system that tries to fight the virus in liver cells.  That is why patients with positive HBeAg and very high HBV DNA often do not have correspondingly serious damage in their livers.

Many lab results posted at the Chinese HBV site are proof that antiviral drugs are effective at lowering HBV DNA to UND and ALT/AST to normal range but sadly many patients still complain of pain in liver area, fatigue, no appetite, cirrhosis, firbrosis, fatty livers and HCC.

That is why the view that HBV patients should not be satisfied with UND DNA and normal ALT/AST only but should demand negative HBsAg and positive HBsAB from their treatments.

[bberry]

"That is why the view that HBV patients should not be satisfied with UND DNA and normal ALT/AST only but should demand negative HBsAg and positive HBsAB from their treatments."

how can we "demand" such thing Jim ? you cant demand something that isnt supposedly there. one can offer something one does not have . so if - so far, there isnt a cure that brings you to  S antigen negative and antibodies postive , then there isnt much one can ask for.

you and i and a lot of people on here have kids.. and you know not a single day passes without me getting depressed about my hbv even for 5 minutes.. every time i look at the two God created rascals running around in the house i cant help but to worry about their future and mine for that matter. its been a year since i found out i had hbv. i must've gotten it some 15 years ago if i am correct about the symptoms that mightve been the acute stage of hbv that i was experiencing.
this thing has a cure.. eventually  that is.. all diseases have a cure.. God has not created a disease without a cure to it.. only two things we can not cure is old age and death. medicine cant cure or prevent that. so it is a matter of time before some cure is found.. hopefully it is found in our time while we are still here.

for how though, i know i can be hopefully and pray to God a cure is here soon but i also know i cant demand it..
one day jim.. one day :-)

[stevenNYer]

"That is why the view that HBV patients should not be satisfied with UND DNA and normal ALT/AST only but should demand negative HBsAg and positive HBsAB from their treatments." -cajim

I take this to mean that HepB patients should push and advocate for continuing research to find a cure.  

"and you know not a single day passes without me getting depressed about my hbv even for 5 minutes.. " -bberry

What helps me is to try to adopt a more universal view.  Disease is a part of life.  When praying, don't just ask God for a cure but remember to thank God that HBV is now a  manageable disease.

[cajim]

My view may be wrong but I will share anyway:  If we patients are not satisfied with only DNA->UND and ALT/AST->normal range, then the scientists may not stay at the stage of curing by killing indiscriminately.  They may spend more efforts at figuring out how to strengthen the internal environment of a patient that will increasingly make it impossible for the virus to stay.  We patients also make our share of efforts: we must be willing to do a lot more than just popping a pill into our mouth for our cure.

[cajim]

That's right.  Also research needs to realize that chronic HBV like all chronic conditions are not very well treated by methods of kill.  Yes, chemo therapy and radiation may have successfully killed all the cancer cells in a patient but at the same time they have so weakened and destroyed their carrier, the human body that the patient also dies with the cancer cells shortly after; Yes, methods of kill have killed HBV viruses to UND but at the same time they have so weakened and poisoned the patient's liver, kidney, and other systems  that the patient gets weaker and weaker with UND DNA and normal ALT/AST!

[Sharp7]

"then the scientists may not stay at the stage of curing by killing indiscriminately"

At the risk of sounding pedantic, I'll say that viruses are not "killed" because they are not really alive.

None of the HBV medicines (as far as I know) actively destroy the virus. They just interfere in the replication process. And the way I understand it, the body's own reproductive mechanisms make the viral load low - by simple dilution - by creating new cells and getting rid of old cells and wastes.

Speaking for myself, I feel a lot better with my undetectable VL. No more feeling bloated all the time, like I used to feel a year ago.

Coming to my own faith: I have faith that this particular disease is fully curable. My reason: most adults get rid of it on their own! Why can't we? Clearly it is curable!  I wish they would speed up research on the natural immune response, and find a way to trigger that in us.

[cajim]

1.  Figuratively speaking, "kill" means "hurt", e.g. Adefovir hurts HBV replication just as it hurts patient's kidney, alive or not.

2.  I am happy to hear that some patients are happy because they have benefited from UND DNA, but may I venture to assume that they will be happier when they get rid of the virus, not just the bloating.

3.  I agree: "most adults get rid of it on their own!" not by antiviral drugs or IFN but by their own body, their immune system, their internal bodily condition.

[bberry]

pump !!!!


i like this topic.. keep it going please :-)

[Sharp7]

"and you know not a single day passes without me getting depressed about my hbv even for 5 minutes.. " -bberry

Personally, I feel fine about it. I ask myself "given this situation, what is the best thing I can do?". Then I try to do it. I have neither hope that medicines will work, nor fear that medicines won't work and the virus will take over. It is always just "Now, what is my best course of action?"

Unlike you, I don't have kids. And I wonder if that makes a difference. I wonder this approach would work if I had kids of my own. If I may hazard a guess, I think it would.

I agree with steven entirely in that disease is a part of life :-).

I'll stop yapping now :-)

[cajim]

"Personally, I feel fine about it. I ask myself "given this situation, what is the best thing I can do?". Then I try to do it. I have neither hope that medicines will work, nor fear that medicines won't work and the virus will take over. It is always just "Now, what is my best course of action?" "

--I admire this a lot.

"And I wonder if that makes a difference."

--I think it would.

"I agree with steven entirely in that disease is a part of life."

--A quote from Dr. Liu,"A natural life is without disease.  That a patient is with a disease is because he/she has made a mistake.  Therefore to cure the disease depends to the larger extent on the patient himself/herself and to the smaller extent on the doctor."

[hepbinme]

I'm happy to see that people are discussing and giving their perspectives on this disease. It's great to see both hope and sorrow because it's a part of life.

Quick question...what does UND stand for? IFN? Undetectable VL?

As of right now, i feel very healthy, just like anyone else. No signs of any side effects. I exercise as often as I can.

As of January: ALT 31/AST 21

[Sharp7]

Yes, UND, though not a standard acronym, stands for Undetectable Viral Load around here.

IFN stands for interferon. Though generally IFN could stand for any of the several interferons, in the context of HepB, it stands for peginterferon alfa-2a. Another note, in medical papers, I have come across researchers testing the efficacy of other interferons as well - for HepB - and they abbreviate to IFN as well.

Please do continue to keep us posted.

[hepbinme]

""So be prepare to see your eAntigen stay positive for some time since there is still too much cccDNA taking hold in your liver cells producing too much eAntigen despite UND DNA.
What's the plan after you go UND?
What is the goal of the study?""

The goal of the study is to test the efficiency of the combo treatment vs single treatment. Prevent mutations of the HepB virus. My doctor hopes that the virus does not mutate. I'll be on it regardless for the next 1.5 years. The study lasts 2 years.

[cajim]

Hat off and a big "thank you" to you for paving the way for safe and effective treatments for people to come.

[hepbinme]

I just wanted to let you guys know that I didn't forget about this thread.

I will be going back for my scheduled visit this Friday, July 11, 2009, for another usual check-up. (includes a physical and blood test).

I will keep you guys updated!

[bram44]

How are latest results ? Are you still combo-ing ?

[jammy65]

Thank you all for this discussion that will definitely give some postive spirit to all the patients to fight with the virus.

Hepbinme: i would like to know you are from which place. If you are from India i would like to know the doctur you are consulting.

[hepbinme]

I have not actually seen my latest results, the last ones were at

• 5th blood results were (taken in April 2009): ON TREATMENT
HEP B VIRAL DNA QT                                      201 H     <160 copies/mL

The 6th blood results should already be out, but I haven't had the chance to review them at the office yet. The doctor said that I should be at a count of at least 0 H (yes, zero). But that doesn't mean that I've cured of it. The treatment only suppresses the virus.

I am still on the combo treatment and will continue to be on it for the next year. The program is for a total of two years.

I apologize that I can not assist you, jammy65, as I am located in California, USA...

[bram44]

Reaching 0H is first step. Please share your success story e-sero conversion (or s-sero conversion)

[longman555]

where do you live? I live in Texas not heard about this kind of study.:)

[stef2011]

hi, can you also clear with your doctor if you were in the immune tollernat fase when you started or just cronic (chronic) hbe +
it is very good to see that such high hbv-dna can be suppressed so fast by the combo of most potent antivirals, any adverse event of ?

did you have a liver bipsy or fibroscan at start of treatment kidneys?

thank you

[stef2011]

sorry for mistakes:
any adverse event on kidneys?

did you have a liver bipsy or fibroscan at start of treatment?

thank you

[biobrain]

I have just started taking viread three days before. After Reading all above I am now depressed. In my case I do not have any goal from my treatment as I am already e antigen negetive.

Should I carry on taking viread to lower my viral count or leave it and put myself on natural response of my own body?  As in both cases I have to suffer and die so then why to take treatment?

Can I take herbal medicine and milk thistle alongwith viread?

I am depresed and need motivation from you people.    

[stef2011]

if your liver has mild fibrosis take something to cure depression

your own body cannot cure infection, if you have hbvdna detectable your body can only help you to die with cancer or cirroshis....

stopping antivirals can be very very dangerous, especially if your liver is damaged already, just talk to your doctor about it maybe you can switch to entecavir but the forum is not the right place for this, your doctor will be able to make the right choice for you

[stef2011]

by the way your goal is prevent cancer and cirrohsis and viread is the most potent antiviral for this, once dna is 0 you are in the same situation as if you have hbs ab...you just need to take a pill to keep this state

consider that when you make hbs ab you still have the virus in the body and also some dna, infact you cannot donate blood/organs even if your hep B is complitely cleared by years

i know a doctor who had hep B and was complitely healed but after taking hep C several years later also hep B came back....

[stef2011]

sorry i confused this is not a good example: he had hbs-ab by vaccine but when got hcv hbs-ab disappeared and got hbv as well, it was very bad luck because got viruses from a needle

but what i meant is that some virus is left in the body even after hbs-ab so taking viread is not bad because you can reach a similar state taking a viread pill

[hepbinme]

Update! Sorry for the delay.

@bram44: 0 H count is definitely a first step. However, I have not sero converted. Until around November, 2010, my combo treatment ended and I was transferred onto another study, but only on one medication: Baraclude.

@longman555: I live in California.

@stefano170669: What is "immune tollernat fase"?
• I was only notified of my Chronic HepB. I only had a liver ultrascan which did not show signs of tissue scarring.
• No adverse kidney issues.
I feel normal. Been trying to train for a half-marathon happening next weekend.

I am now on Baraclude, one pill a day.

[stef2011]

good to know this combo can be stopped on hbe seroocnversion by using only one drug.do you know the reason to use entecavir instead of tenofovir since it is a weaker drug?you have also to consider that tenofovir has 16% hbsag seroconversion by 3 years on hbeag positive at start of therapy so entecavir was really a bad choice since hbsag seroconversion is much lower than tenofovir for you

did they measure your hbsag quantity?

are you still with the researchers now or switched to normal liver specialists?i guess the next best move is a combo of entecavir with immune modulators like interferon and alinia

[nayana_]

I am about to start combo treatment.
What was your drug combination dosage?
I developed resistance with epivir so I can not use baraclude alone and Viread is too toxic so we are going to try combo treatment so I am interested in your Recipe.

[phihungmd]

Are you treated in this study :"Entecavir Plus Tenofovir Combination Therapy Versus Entecavir Monotherapy in Naive Subjects With Chronic Hepatitis B" ?
How about your test ?

[stef2011]

viread cannot be used on those with kidneys disfunction, i am one of those....but fibroguard is able to repair kidneys and lower creatinine, i do think you should try fibroguard and see if you can tollerate viread, this is because once you hve epivir (lamivudine) resistance there are no drugs except tenofovir

what combo are you going to make?without tenofovir there are no comboes that can work on you

you may try: interferon+tenofovir (viread) but i d never use entecavir even in combo because with epivir resistance you are already resistant to etv

[nayana_]

Hi
Thanks for your comments.
Before I answer your question let me explain situation I am in.
I start HepB treatment about 11 years ago with epivir  and within a year I start developed resistance so I switched to Hepsera for about 10 years ago and swithed to viread  4 years ago to present time because it is better drug. But while I was taking Hepsera  my kidney failed( I might had weak kidney but I blame hepsera for blame) and I was on dialysis last 8 years until I had kidney transplant this year July.
We are aware of how toxic viread is to kidney and taking viread was o.k while I was on dialysis because my kidney was already not working but now I need to use new drug to lower hep B virus and same time protect my new kidney.I was taking  2 viread per week after transplant but doctor just increased to 3 per week. This is why we are thinking about combo treatment. So instead of keep increasing Viread as my kidney function become normal we want to add baraclude as supplemental drug.
My option is switch to baraclude until it develop resistance and give kidney to fully recover from surgery or use combo treatment of viread as primary drug and baraclude as supplemental drug and hope it will give more time to develop resistance.
And about fibroguard. Is it FDA apporved drug or supplemental health drug?
I am not sure my doctor will approve to use of fibroguard. I'll do some research to do. Thank you.

[stef2011]

Is it FDA apporved....

forget FDA, it is a disgrace for US citizens, nothing to do with sfety.please refer to europeans FDA which has much less influence from durg makers and more reliable

fibroscan is the only tool to see and monitor liver damage, it is not approved in US and probably never will because we have it available since year 2004.the reason is probably put everyboy on antivirals because biopsy cannot monitor liver damage but you can just make it once in years

US is getting to the point that they cannot present good data because biopsy is no longer used in europe/asia to detect liver damage because fibroscan is the main tool for that

[stef2011]

sorry too tired read fibroguard as fbroscan...

fibroguard is just a blend of antioxidants that are able to regress cirrhosis/fibrosis and of course has good influence is on all organs.check hepatitistechnologies website

with the transplant story is getting very complicated, you should have a resistance test first to know all mutants for sure, possibly a test that can reach as low as 5% of virus population, so that we can get even the low level mutants and then choose tnf+etv

heptech is also used without antivirals and is able to stop fibrosis/regress cirrhosis despite active viral infection with hbv or even hbv+hcv+hdv superinfection but in your case you have immune suppressive drugs so not an option without antivirals

what is your liver damage on biopsy or fibroscan?

[stef2011]

there is also a new version of tnf without kidneys damage, i posted about 1 years ago

i remember the name now
http://www.chimerix.com/
http://www.chimerix.com/therapeutic-programs/category/cmx157

i think they want to rycle viread as patent expires and this should not be allowed because the patent can go on forver if you just change parts of the chemical...but anyway this has no kidneys tox, this would be the solution if you can get it.
it will reach market as tnf expires, i guess around 2015

[nayana_]

Thank you so much for providing value information.

I had liver biopsy in early 2000 and saw  few scar tissues but functioning normal and viral level was undetectable. This was few years after taking viread.  
Since than I had CT scan regularly and no changes noticed. However, I had false alarm because they saw tumor on liver in late 2000 and I had to go through 3 days of testing to put me on liver+ kidney transplant( by the way, doctors were so sure they did not bother to biopsy to confirm I have cancer. I was at UCLA). But it turns out to be a false so I am not sure it was good thing I did not have cancer or it would been better to have liver + kidney transplant same time because I heard it would be better to get liver and kidney from same person rather than receiving kidney and later get liver from different individual then it will create whole a lot new problems to deal with.

I will talk to my doctor about resistance test so I know what to expect with drug resistance and ask about new version of tnf without kidneys damage.

[stef2011]

aslo do consider heptech and read all researxh behind it, it will keep you free of fribrosis and probably allow viread without damaging kidneys

hep tech is not a drug company but a team of researchers, the most advanced in the world about liver, which teamed to produce it, study it and make human trials for the studies.it is ll antioxidants so it is good or everybody except it is expensive