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Do I need any treatment?
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Do I need any treatment?

I was detected positive for HBsAg in 2014 February .I doesn’t know when I got infected. My age is only 23 now.
My recent tests result:
HBsAg +ve (5811.45 IU/mL)
HBeAg -ve
Anti HBe +ve
HBV DNA: Undetected (20/02/14)
ALT 32 U/L
AFP: 0.8 ng/ml
USG : Normal
Endoscopy: Normal
Serum Bilirubin (T): Normal
Prothrombin Time (PT): Patient: 12.7 sec, control: 11.8, Normal Range 11-16 sec

My Question
Do I need any treatment?
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Avatar_m_tn
Definitely go for pegasys
19 Comments Post a Comment
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Avatar_m_tn
Definitely go for pegasys
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Avatar_n_tn
What is pegasys ???
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Avatar_n_tn
I see one article, if HBV DNA undetected it patient no need to treatment
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Avatar_m_tn
it is very good to try peg, hbvdna undetected will allow better response to peg because there is less suppression of interferon pathways

hbsag is not ideal like 1000-3000iu/ml, but 5000iu/ml does not mean you will not respond, 24 weeks of treatment will tell if you will respond or not by hbsag decline
which country are you from?genotype A has higher hbsag and may have good response despite this value

you need a very good and updated liver specialist, most are ignorant and cannot make a personalized hbv therapy but blindly apply standard guidelines, which is not the best
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Avatar_m_tn
Can you guys reffer to any research that support your recommendations?
I did not see any study giving more than 30% probability to hbs ag seroconvertion on interferon. Dependance on baseline DNA is also questionable.
Doctors refuse to give any treatment with DNA undetectable - I saw many famouse doctors in differnt  countries and all say the same - no treatment!

Could ypu please post here the studies supporting your advice so everybody could see it?
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Avatar_n_tn
Dear guys my doctor (MBBS, FCPS, MHPE Chicago, FRCP Edin, Fellow hepatology & Gastroenterology USA & Singapore, Professor & Chairman Department of Hepatology BSMMU) He advised me , now I no need to any treatment., he also advise after six month check again HBV DANA.
Please help me….. Thank You
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Avatar_m_tn
You are right, you do not need treatment now, because your hbvdna is undetectable and you are in the Immune Control (aka inactive) phase. What others suggested here is a treatment method that may lead to clearance of the infection. However, this treatment in the Immune Control phase is not accepted by all doctors as they would like to see more clinical evidence. It is recommended by some progressive researchers.
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Avatar_m_tn

HIGH RATES OF HBSAG SEROCONVERSION AFTER TREATMENT WITH INTERFERON ALFA IN CHRONIC HEPATITIS B VIRUS-INFECTED PATIENTS WITH UNDETECTABLE HBV DNA

H.B. Yu1*, Z.H. Cao1, Y.H. Zhang1, L.N. Ma1, B. Ma1, Y.L. Liu1, Y. Jin1, X.D. Zhang1, H. Wu2, X.Y. Chen1
1International Medical Department, 2Department of Infectious Diseases, Beijing You'an Hospital,Capital University of Medical, Beijing, China. ****@****


Background and aims: The patients infected by hepatitis B virus with undetectable HBV DNA, HBeAg negative/anti-HBe positive are not recommended to receive antiviral therapy currently. However, HBsAg seroconversion is considered the closest outcome to clinical cure and associated with the good long-term prognosis in chronic hepatitis B (CHB). The immune characteristics of B cells and their clinical implication during this treatment in those patients remain unclear. The aim of this study is to investigate the efficacy of antiviral therapy and immune characteristics of B cells in those patients .
Methods: Patients with undetectable HBV DNA, HBeAg negative/anti-HBe positive and HBsAg positive were enrolled, and treated with interferon (peginterferon alfa-2a 135µg/week (n=53) or 180µg/week (n=14) or peginterferon alfa-2b 100µg/week (n=16)). When HBsAg titer300 IU/L) was set to the terminal of the therapy .Flow cytometric was performed to analyze the peripheral total B cell percentages in 3 patients who achieved HBsAg seroconversion and 2 HBsAg-vaccinated healthy controls.
Results: Of the 83 patients received interferon treatment, 26 (31.3%) achieved HBsAg clearance(n=1) and seroconversion(n=25). HBsAg seroconversion occurred after a median of 30 weeks after the treatment (range: 12-132 weeks). Eight patients had completed treatment and were followed for a median of 30 weeks post-treatment (range: 24-60 weeks). All of them sustained HBsAg seroconversion (mean anti-HBs 473.1±298.7 IU/L) during the post-treatment following up. 18 patients are still undergoing treatment (mean anti-HBs 411.2±461.7 IU/L ). The data (3 patients achieving HBsAg seroconversion and 2 HBsAg-vaccinated healthy individuals) indicated that circulating B cell percentages were close to healthy controls at baseline(range:5-7%)and were increased after the HBsAg clearance(range:16-19%).
Conclusions: Patients whose HBV DNA are undetectable in plasma, HBeAg negative/anti-HBe positive and HBsAg positive should be treated, because they can achieve high rates of HBsAg seroconversion. B cells may play an important role in HBsAg clearance /seroconversion.
Financial support: National S&T Major Project for infectious diseases Control (2008ZX10002-013;2008ZX10002-004);863 project (2006AA02A410)
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Avatar_m_tn
Good research but it is still only 30%, what happened to the other 70%? What genotype they had?
It would be great to see the dynamics during the treatment.
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Avatar_n_tn
Is it possible to clearance HBsAg ?
how many chances clearance HBsAg  for my test report?
please help guys.....
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Avatar_m_tn
It is possible to clear HBsAg naturally or by treatment.
In your case, I am not a doctor or expert, so this is just my opinion based on my understanding from reading the literature.

A portion of people in the Immune Control phase do go on to clear the HBsAg without treatment. This usually occurs with increasing age and may depend on genotype of the HBV. (please note, some in Immune Control phase may transition to the Immune Escape phase that requires treatment).
In your case, I don't think you will clear HbsAg in the near future as your HBsAg quantity is > 1000 iu/ml. Research from Hong Kong indicates if your HBsAg is < 100 iu/ml, then you have a very high chance of clearing the virus naturally in the next few years.
Hence the logic behind using Pegylated Interferon to try to lower HBsAg to < 1000 iu/ml, below this threshold, research indicates our own immune system may be revived and kick in to then clear the HBsAg.
Clinical studies to confirm this type of thinking are eagerly awaited.
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Avatar_m_tn
Rome is right, those are just small trials that need to be approached with moderation/caution. Doctors need to balance risks and maybe its better to leave it as it is with normal ALT and UND DNA (A situation a lot of us pray for) instead of risking sides and potentially flaring up his hepatitis.

For me interferon didn't work and 4 months after completing full course ALT is twice it was before IFN and viral load is 1log higher now.

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Avatar_m_tn
that is the only study i can find.... there was another meant to take place in amsterdam but i cannot find any study results.....i also would like to see more info
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Avatar_n_tn
If I take Antiviral treatment then what Advantage or Disadvantage?
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Avatar_m_tn
antivirals are useless for you, they have activity on hbvdna only, your hbvdna is undetectable already...so they re useless

another point is antivirals lower hbvdna only, they dont make it undetectable in the liver, your immune system has already done much more than antivirals can do
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Avatar_n_tn
Thank You stef2011,
And I inform you that I am never have been feeling sickness.
Do i need any special diet?
Can live normal life with CHB?
I can I kiss my girlfriend?
Do I have any risk in future?
if have any risk how i protect that risk please tell me

Please help me
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Avatar_m_tn
hbvers never feel bad, just tired from time to time but tht can be anything

yes to all but my point of view is pegintf, pegintf and pegintf when there is chance to get rid of hbv

normal life, no not totally, it must be healthy life

you risk liver cancer and only way to lower risk is hbsag less than 1000iu/ml or clear it to make risk almost zero like general population
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Avatar_n_tn
pegintf ??????
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Avatar_m_tn
What Stef means peginterferon alfa-2a
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