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Does anti-viral drugs help reduce HBsAg (or maintain it) at all?
Guys,

My wife has her HepB reactivated after she delivered a baby 3 months ago. Below is her data. Looks like she has two options: Nuc or Nuc+Peg. Judging by her relatively low HBsAg (1128 IU/ml ), it seems worth a try with Nuc+Peg, but 1128 IU/ml is still now low enough to get highest chance of cure. I am thinking starting with Nuc first, and add Peg after a couple of years when HBsAg further drops, as Steff had suggested to me. My question is: Are we running the risk of HBsAg going up if we use Nuc only without Peg for a couple of years? After all, Nuc does not have a direct impact on HbsAg.

Thanks!

ShawshankHK


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My wife's data:

HBsAg: 1128 IU/ml
HBsAb: <6.4 mIU/ml
HBeAg: 224 CI
HBeAb: <30 INH%
HBcAb: 99.9 INH%

ALT:                116 @ Jan 4; 195 @ Jan 6; 173 @ Jan 8 ,2014
AST:                130 @ Jan 4; 130 @ Jan 6;  98 @ Jan 8 ,2014
Bilirubin Total: 16.4 @ Jan 4; 11.7 @ Jan 6; 9.4 @ Jan 8 ,2014

HBV DNA: 5.4x10^5 copies/ml, 1.1x10^5 IU/ml
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sorry correct a typo:

"but 1128 IU/ml is still NOT low enough to get highest chance of cure"
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yes you risk some increase of hbsag but that is not important to sequential, response after sequential is not correlated with hbsag level anymore, the highest hbsag on the trials was 7900iu/ml and hbsag was cleared by 96 weeks of combo (not by 48weeks)

you may try a combo like this if allowed:
tenofovir plus telbivudine (telbivudine has a very strong immune activating effect similar to intf), this for 1 year

then you stop telbivudine and add on peginterferon

telbivudine cannot be safely kept during peg because there were an increase of PN to about 14% instead of 7% on telbivudine
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if genotype is D she may try pefintf mono and if there s no hbsag decrease by 24 weeks go for sequential.1100iu/ml is low enough for genotype D
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another thing just came to my mind, during pregnancy there is a rise of nagalase to protect the fetus from immune system attack and there is immune suppression.
there are no studies on nagalase after delivery and immune reconstitution, so also this fact may not be good for pegintf mono
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as to the title of the post, tenofovir lowers hbsag on most patients but the decline is very small and slow.according to data of trials they calculated the time of hbsag clearance on all antivirals and tdf was 17years, etv something like 34 years, the others lifetime

some patients have increase of hbsag on antivirals, but this happens also with pegintf
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Thank you very much for your so much detailed explanation, even with things I haven't thought about at all. We are planning to have a 2nd child, so I think a safe option for us is to start Tenofovir first, then get the baby thing done, this would probably take 2-3 years. Then take a look at the situation, and see if it'll be optimal to add peginf then.

BTW, we booked a VitD test as you suggested, what had disappointed me back there was that we had actually mentioned her Arthritis condition before, but the doctor didn't connect the dots with HepB, until I suggested a test of VitD, and then she immediately agreed, but I thought such thing would be suggested by her but not me (if not you have told me that).

Next month when we go to see the doctor we'll suggest a Genotype test, my wife is Asian (me too) so I'm afraid her chance of type D is not that large, but we need to know exactly what type after all.

Finally, on the point that TDF by theory could achieve hbsag clearance by 17 years and ETV about 34 years, could you find its source? I noticed that you mentioned it multiple times, and it really have given us a lot of hope. A source would do great help here.

Thank you again for your help Stef, you have given me and my wife a lot of knowledge and support since we joined the community.
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i posted the link, we should check older posts or try google again

unfortunately medhelp search engine is not that good and there is so much info and interesting links in old posts, i ll try this search again tonight when i got some time, in the meantime you also try looking older posts
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http://www.medhelp.org/posts/Hepatitis-B/tenofovir-has-fastest-hbsag-decline-than-other-nucs-hbeag-/show/1941070

i got it, easier than thought
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Stef,

Thanks a lot for this. If you don't mind I'd like to make a post on this link, so that guys in the community get to know that easier, not at the bottom of a post.

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What makes you say her HBV reactivated. You're only showing lans of one month.
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I know the standard should be to monitor for like 3-6 months, we are under 1 month watch given by the doctor, and see how it goes, hope it gets better so we could keep on just monitoring
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