Decrease in HBsAg

[Mars86]

I'm on combo etv .5 and tdf for 3 years till now ,,, last month results was

HBsAg was 34,000 iu/ml , base not known (but randomly tested after one year from staring treatment it was 87,000 iu/ml)

DNA 66 iu/ml (base was more than 170 million iu/ml)
normal AST , ALT was slightly elevated (60 iu/ml ) max. normal was till 50 iu/ml... base was normal ALT and AST (about 35 iu/ml)

I was forced to stop etv for only 20 days ... then tested again yesterday ... results

HBsAg 27,000 iu/ml
DNA not tested
normal AST , ALT was slightly elevated (63 iu/ml ) max. normal was till 50 iu/ml...

My Q can I stop etv now and continue with tdf only and vit D3 10,000 iu daily ?

Thanks

[Aduiski]

You should check your hepatitis B genotype, and in the case you are genotype A then I would go for add on Pegasys (together with TDF) ... in which case you should find a good liver specialist who has experience in treating with Pegasys.

[stef2011]

peg has the poorest response on C and D and the best response on A but its best to try 12-24 weeks and see because you can be among the responders even being D

[Mars86]

sure I will not stop , but does it make a response to gen D ?

[stef2011]

no dont stop for genotype if most egypt is D you are almost certainly D

[Mars86]

is it safe to stop it for 2 weeks ?

[Aduiski]

that is right you would have to stop TDF for maybe 2 weeks or so, take a blood test and then on the same day continue with TDF...in order to get your genotype...

...whether to go for Pegasys is always an individual decision...if you are going to go for it then now might be the right time to do that as Pegasys works better for younger people as well produces less side effects on young patients. On the other hand it sometimes can have substantial side effects so you would have to be under a close care of a good experienced doctor...

[Mars86]

thanks a lot , but i reviewed what is the popular genotype in my country (Egypt) , I found it is Genotype D ,, as well due to DNA is undetectable I could not know what is the genotype exactly

[Mars86]

i do not know the geynotype but i am still HBeAg positive..

ALT is above the normal limit , it is about 75 iu/ml

male , 30 years

[Aduiski]

To make a decision on whether to start pegylated interferon...

- what is your hepatitis b genotype?
- what is your ALT at the moment?
- what is your age and sex?

[Mars86]

i do not know the geynotype but i am still HBeAg positive..

ALT is above the normal limit , it is about 75 iu/ml

male , 30 years

[Aduiski]

"last egfr was 116 , lower limit is 125"

I think you are mixing up your test results, as egfr >90 is an excellent score for egfr, and can not have a lower limit of 125.

Your microalbumin is not measured by egfr, but with urine test that measures levels of albumin in urine and is often expressed by either:
- albumin/creatinine ratio
- albumin
- albumin excretion rate

you can measure egfr with blood tests, either with creatinine or cystatin c or both (as steff recommended).

I would follow steff's and studyforhope's advice (i followed them actually just recently when evaluating my own kidneys)...

In any case...I would advise switching to TAF when it becomes available at your location

[Mars86]

fine I'll apply those tests and let you know


:about pegylated interferon ? what is the correct time to start treatment ?

Thanks

[stef2011]

egfr is not good because theoric based on creatinine which is not itslef a good measure of kidneys function, best tests a combo of:
serum creatinine
cystatin c
creatinine clearance by 24hrs urine collection
serum phosphate
Albumin/Creatinine Ratio

[Mars86]

is i ok to start IFN now ?

[Mars86]

itis going worse I think , last egfr was 116 , lower limit is 125

[Aduiski]

How is your Macroalbuminuria going...is it improving or getting worser?
Also, when did you notice it for the first time?

[Aduiski]

Excellent news...about your viral load

[Mars86]

now DNA is UND , HbsAg is about 12000 Iu/ml , this is on TDF mono + Vit d3

is it time to add on inf or to wait ?

Thanks

[Mars86]

I'll go with tdf monotheraby and check results again within 3 months and keep u posted.

thanks

[stef2011]

using both drugs is better if you can afford it since hbvdna is und on both drugs and hbsag is declining, so good results

but also using tdf monotherapy is ok if hbsag keeps declining and hbvdna goes slowly to undetectable.there is no risk of resistance with tdf even if hbvdna is detectable very low but it would be best to get it undetectable by 6 months of tdf only

[Mars86]

dna b4 stopping was 66 iu/ml ,,, after stopping by 3 month 96 iu/ml

i c it is time to stop etv forever and continue using tdf only ..

I need you advice if any..

[Mars86]

I'm on combo etv .5 and tdf for 3 years , stopped etv with my choice for 3 months till now

results after stopping by 20 days
HBsAg 27,000 iu/ml
DNA not tested
normal AST , ALT was slightly elevated (63 iu/ml ) max. normal was till 50 iu/ml...

results after stopping by 3 month

HBsAg Q 25800 iu/ml .. decresed
HBV DNA Q 96 iu/ml .. slightly increased
ALT 79 iu/ml ... slightly increased
AST 32 iu/ml normal

[Mars86]

PLEASE read the thread from beginning

[stef2011]

absolutely not, etv is not working if you are over 6-8 months on it, hbvdna must be undetectable and even when undetectable antiviral can only be stopped when hbsag less than 400iu/ml or after 48weeks combo with peginterferon (if there is peginterferon response=hbsag less than 400iu/ml)

how long are you on etv?

[Mars86]

dears

your input in this case will be highly appreciated.
Thx