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Finally got the first "full picture" of my results... Should ...
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Finally got the first "full picture" of my results... Should I start treatment?

ast 18 (ref range: 10-30 u/l)
alt 19 (ref range: 6-29 u/l)
vit d, 25-oh, total: 28 (ref range: 30-100 ng/ml)
pth intact 35 (ref range: 14-64 pg/ml)
hbsag positive
hbsab negative
hbcab positive
hbeag negative
hbeab positive
hbv dna 1311 ui/ml
hbsag count ??? ui/ml (can't do the test in the US, but I'm guessing it's going to be more than hbv dna?)
alpha fetoprotein tumor marker 2.0 (ref range: <6.1 ng/ml)
liver fibrotest score: 0.29 (F1) minimal fibrosis
acti test (assesses activity (inflammation in chb)): score 0.05 (A0) no activity.
hep a ab negative (should I get vaccinated?)
hep d co-infection negative
Ultrasound: No significant abnormality is identified.
tests pending: hbv genotype

What do you think guys am I a good candidate to start treatment? If so, what treatment plan would you advise? Is peg-Intf an option? How likely will my fibrosis progress to F2? What phase do I belong to (e.g. immunte tolrent, clearance, inactive, etc)? How often should I monitor myself? Also, would it be beneficial to get a FibroScan in addition to the FibroTest I already got?

I'm going to discuss with my gi about my treatment options this Tuesday, and also going to have a second opinion appt with a hepatologist specialist next month. I would also appreciate if you could recommend good docs in LA area.

Thanks for your help!

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Avatar_m_tn
doctors .... 10 or more years ago one doctor told me that I'm non-infectionous and I'm ok with my hbv, he even didn't told me that I have to monitor this, because 10 years ago they believed that HBe-, HBeAb+ and undetectable dna (10 years ago und dna was probably < 200 or 500) is very good outcome. Now we know it's bulshit.
So remember that not all doctors are up to date and also they don't want to take responsibilty about any actions out of official regulations.
Bringing PTH to minimum is not your target it's just signal that you have obtained your max safe vit d level when vit D has the best immunoregulation effect.
42 Comments Post a Comment
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Avatar_m_tn
vit d, 25-oh, total: 28 (ref range: 30-100 ng/ml)
pth intact 35 (ref range: 14-64 pg/ml)

looks like you have little vitamin d receptors resistence, increase vit d3 dose to make it 100ng/ml at least, you are very deficient for hbvers optimum levels are vitd25oh 100ng/ml and pth 14pg/ml (per your lab min range)

hbv dna 1311 ui/ml
lets see how this changes when you are stable pth at 14 for 6months, i d not check vitd25oh but only pth it reflects vit d sufficiency better than vitd25oh

hep a ab negative (should I get vaccinated?)
no

What do you think guys am I a good candidate to start treatment?
without hbsag quant we cant say
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Avatar_m_tn
I had similar results as itac when starting supplementation.
PTH 28 pg, vit D3 23 ng.
To move iPTH down to 16 pg I took 5000 and than 10.000 D3 for two months total and obtained d3 level 117 ng.
When I decreased supplementation to 5000 IU for one month, PTH went back to the starting level, 27 pg even if my vit D level was almost 99 ng.
So in my case D3 level to move PTH down is around 110-120 ng and maintain dose will be around 7000 IU probably.
It's just an example, everyone is different but you can see some tendence.
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Avatar_m_tn
What benefit do you get from having your pth at the minimum? Does it reduce hbv dna? Does it improve chances to seroconvert? Any studies done on the subject?
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Avatar_m_tn
Why do you think vaccination for hep a is a bad idea?
Also, let's say my hbsag is 3-4k ui/ml, what would you advise in that case? Is there a table range where you can decide to treat or not?
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Avatar_m_tn
pth at minimum means you have normal/optimum vit d because pth responds to vit d (inversely).vitd25oh can be good to monitor vit d if your receptors are perfect but pth is better because it lowers only after vit d has attached receptors

so in the end iPTH is the best indicator of vit sufficiency and vit d sufficiency means all the pros of having normal/good vit d levels and immune modulation
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Avatar_m_tn
Why do you think vaccination for hep a is a bad idea?

yes because it is never chronic and being in US i dont think you may get contaminated food and so get hep A.it also doesn t help immune system who knows it may have interference with response to hbv

for the rest have a holiday in mexico, canada, europe for hbsag quant or call some mexico labs in spanish i think they have the test there, once they have abbott machine or even better roches elecsys they have the test
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Avatar_m_tn
without hbsag quant we are blind on everything
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Avatar_m_tn
"pth at minimum means you have normal/optimum vit d because pth responds to vit d (inversely).vitd25oh can be good to monitor vit d if your receptors are perfect but pth is better because it lowers only after vit d has attached receptors

so in the end iPTH is the best indicator of vit sufficiency and vit d sufficiency means all the pros of having normal/good vit d levels and immune modulation"

But a low level of PTH in the blood is known as hypoparathyroidism:
http://en.wikipedia.org/wiki/Hypoparathyroidism
'calcium replacement or vitamin D can ameliorate the symptoms but can increase the risk of kidney stones and chronic kidney disease'

Is that really desired goal of treatment? Is there any evidence bringing the pth to the minimum can actually "cure" people or reduce their hbvdna/hbsag without damaging their kidneys? Are there any evidence/studies/previous posts of users that imply this actually works?
I asked my gi about this, he just said vitamin d should be at least 30 (minimum level)... But he wasn't saying I need to bring it up to 100... and bring the pth to minimum... I doubt any doctor aware of this... plus it sounds a little extreme to take big doses of vitamin d... If at least you could provide some evidence (links, studies, previous users posts) that this actually help with chronic hepatitis b (not with vitamin d deficiency) that could be helpful, thanks.
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Avatar_m_tn
doctors .... 10 or more years ago one doctor told me that I'm non-infectionous and I'm ok with my hbv, he even didn't told me that I have to monitor this, because 10 years ago they believed that HBe-, HBeAb+ and undetectable dna (10 years ago und dna was probably < 200 or 500) is very good outcome. Now we know it's bulshit.
So remember that not all doctors are up to date and also they don't want to take responsibilty about any actions out of official regulations.
Bringing PTH to minimum is not your target it's just signal that you have obtained your max safe vit d level when vit D has the best immunoregulation effect.
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Avatar_m_tn
I understand not all doctors are equals and some are better than others...

"when vit D has the best immunoregulation effect" - How does that help to cure chronic hepatitis b? Is there an evidence it actually reduces hbv dna/hbsag? Is there one case in this forum of a person who got seroconverted based on maxing his vitamin d levels?

Also, what is the long term effect of taking big doses of vitamin d on the kidneys (getting stones/etc)?

What I'm trying to say is there is a big obsession in the forum how vitamin d/intact pth is very important, but they clearly fail to explain how exactly does it help or if it's even proven to help to hbvers. To me it sounds like coping mechanism that there is no effective cure... So these people try to be pro-active by doing something, which I doubt has any really significant benefits... I mean you took vitamin d, how did it help you personally? Are you cured now?
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Avatar_m_tn
plus low ipth (low normal) is healthy, avoid osteoporosis and so on....high end of normal ipth means vit deficiency, osteoporosis development over the years and bad immune responses (because high end of normal ipth is vit deficiency)

we dont take a lot of vit d we take the dose to make our vit d normal, in disease most have vitamin d receptor resistance so you can t see your vitamin d levels from vitd25oh, most of what you see in vitd25oh is useless because it doesn enter your body in the sense it just circulates in blood uselessly (to say with very easy words, it finds all doors closed)
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Avatar_m_tn
reverse all questions.....the receptors are closed so what we take is doses to make our vit d normal...all the ******** made up by most drug makers and doctors is for perfectly healthy persons, when you have the receptors closed 200.000iu of d3 is like taking 2000iu.....so in the end your question shold be what happens living with vit d deficiency with vitd25oh 150ng/ml but ipth 70pg/ml?

hope everything is clear because i cannot explain it further if you dont get it by these examples
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Avatar_m_tn
of course all this balance of vitd25oh, iPTH and calcium when we have vitamin d receptors resistance requires an expert doctor, a diet with no dairies at all and 2.5l of low calcium water and calcium monitoring for safety because the receptor resistance is different person to person and the doses must by found by monitoring

anyway it is probable that the level of resistance go with severity of disease:
sorte has little resistance 7000iu is probably his dose, i have much more resistance (regressed a cirrhosis) 150.000iu another member with cirrhosis can t do anything to rise vit d even with 450.000iu....

this is a research article about those with severe liver damage where the liver is not able to work vit d
http://www.vitamindwiki.com/400%2C000+IU+barely+raised+liver+transplant+candidate+vitamin+D+levels+%28no+surprise%29+%E2%80%93+March+2015
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Avatar_m_tn
You still didn't answer my question.
I'm asking how does restoring vitamin d levels helps curing hepatitis b?

real life forum members examples?

studies?

anything?

I know you are a big advocate of vitamin d... But it sounds like it solves unrelated problems to hbv... Most of people today suffer from vitamin d deficiency, it's not a big deal. On the other hand, have you ever thought what are the long term effects of taking vitamin d on the kidneys? If taking vitamin d doesn't cure hbv, then why risk your kidneys? What's the point...
You are saying that taking big doses doesn't harm because hbvers have their vitamin d receptors doors closed... but it still has to go through the kidneys if it doesn't find it's way in, so it go out right?? Who said this vitamin d wasn't absorbed in the first place? Are there any studies the backup your claims? To me it sounds like pseudoscience...
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Avatar_m_tn
check older posts for studies
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Avatar_m_tn
but regardless all the studies on keeping optimal vit d for cancer, cirrhosis, fibrosis etc vitamin d must be kept optimal and not defcient

this website gathers all the studies per disease you can start from here
vitamindwiki.com
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Avatar_m_tn
by optimal, you mean normal right? I mean having something from 30-100 range is considered sufficient... a real vitamin deficiency is below 20 where between 20 and 30 is insufficient, that's why I changed my daily dose from 1000iu to 2000iu.. But I don't think bringing it to max will have much more difference...

I did find some old posts of people who took lots of vitamin d... at the beginning they might had some progress with reducing the viral load, but later it didn't seem to really make much difference, where they could actually benefit from it... for example the user Rome70:

"Rome70
Jan 07, 2014
To: stef2011
Just have got december results

Date/25(oh)/hbsag/dna/vit d3/1,25 oh
July/58/1590/<20/10000
Aug/64/1426/<20/10000
Sep/70/1891/86/10000
Nov/34/1856/56/5000/82
Dec/48/1907/50/10000/89

Obviously if correlation will vit d3 and hbsAg exists it is negative...

Vit D suplementation did not help to decrease hbsag at least for me... "

Plus I found this:

"Vitamin D Supplements Won't Help Prevent Disease: Review
Low levels of 'sunshine vitamin' could be a sign of illness, rather than a cause, studies suggest"

Link:
http://www.webmd.com/vitamins-and-supplements/news/20131205/vitamin-d-supplements-wont-help-prevent-disease-review
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7951432_tn?1424719262
  vit d plays  role for our immune system.
Most of people live with very low vit d level(but they are normal people)we hbvers could always take things wich helps our immune system to be strong.to do not give virus chance to do damagedto our liver.personally last year I had joint pain and feel these pains every where .when I went to doc and gave me check I have very low level of vit d wich correspond wit activation of virus.so when I took ampule I feel better and each 3 month i do a test to see it level especially I live in country where there is less sun.i don't take it every day but just take ampule accordingly to my test result.and many other substance wich helps our immune syst and each body react differently.
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Avatar_m_tn
"to do not give virus chance to do damagedto our liver" - it's not proven that taking vitamin d will prevent liver damage, are you saying it's effective as the anti-viral drug? Also you are you saying it's helping the immune system but to what extent, is it effective as interferon? I doubt if, unless you can provide evidence. Yes different body react differently, but without clinical studies and getting significant statistical conclusion you can't guess how effective it is, sorry.
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Avatar_f_tn
But in one study i read it has an effect in order to seroconvert i can't provide the source though because it has been a while now.
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7951432_tn?1424719262
I am not saying it plays a role of anti viral but any thing helps our immune system sure  assure prevention of reactivation of virus and liver damage.not just vit d.not go far on any study just read on google what is the role and benifit of vit d.or on drug notice.
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Avatar_m_tn
I guess you refer to this article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692974/
"Normal vitamin D levels are associated with spontaneous hepatitis B surface antigen seroclearance"

"Our study contains some limitations. The link between vitamin D levels and HBsAg seroclearance was not shown to be causal but associative. The retrospective pattern of this study was unable to determine the cause effect of vitamin D levels to HBsAg seroclearance. More studies with a larger number of patients and with a prospective and controlled design are needed to confirm this hypothesis. Furthermore, this study did show that a very high percentage of spontaneous converters do have high levels of vitamin D but this percentage was not compared to a similar group of patients with hepatitis B without a spontaneous seroclearance."

In other words, it doesn't prove that vitamin d is the reason for serocleareance, it could be the people who had normal vitamin d levels was caused by some other reasons in their body.. it doesn't mean if you get normal vitamin d levels by taking supplements will get you the same result (seroclearance) as those group of people. Without more studies, it cannot be determined.
This is what they used to consider below normal levels:
Below normal levels of 25 (OH) vitamin D ≤ 30 ng/mL

Laboratory, demographic and clinical data of the two groups n (%) or (mean ± SD)
Normal levels of 25 (OH) vitamin D (n = 44): 31 ± 4
Below normal levels of 25 (OH) vitamin D (n = 9): 13.5 ± 7.2

Even those who had normal levels of vitamin D around 27-35
that seroconverted didn't have their vitamin D levels at the max like Stef tries to say that is needed...
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Avatar_m_tn
The question is not only what is the benefit, but what is the risk of taking big doses of vitamin d that can cause to your kidneys...
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Avatar_m_tn
Of course there is a risk. If something is expected to work it may also harm. That's why you monitor urine calc, serum calc and PTH to adjust supplementation.
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7951432_tn?1424719262
I am against big quantity personally take it just when there is luck after blood test
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7951432_tn?1424719262
I am against big quantity personally take it just when there is luck after blood test
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Avatar_m_tn
"Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients"

http://onlinelibrary.wiley.com/doi/10.1002/hep.26488/full

In view of the above-described data, vitamin D deficiency in liver diseases does not appear to be specific for distinct entities. Nevertheless, our study highlights an important specific feature of vitamin D metabolism in CHB, because the strong association between 25(OH)D3 and HBV DNA serum concentration is in sharp contrast to results of numerous previous studies in patients with CHC, which failed to show an association between vitamin D serum levels and HCV viral load.[17-21, 27-30] In this regard, the observed inversed seasonal fluctuations of 25(OH)D3 and HBV DNA serum levels might be considered as an important hint for a functional relationship between both variables.

The possible causal relationship between vitamin D metabolism and HBV replication, which needs to be proven by future studies, may offer attractive therapeutic opportunities for treatment of CHB. As highlighted above, the addition of relatively high doses of cholecalciferol to standard therapy was superior to the addition of placebo in the treatment of patients with lung tuberculosis.[14] In this study, as well as, for example, in studies in diabetes patients, vitamin D supplementation resulted in a profound change in serum and cellular cytokine profiles.[16, 31] For treatment of chronic hepatitis, the development of novel immunomodulatory agents appears highly relevant. Such agents might be suitable add-ons to both treatment of with Peg-IFN-α or NAs to increase the chance of long-lasting immune control of HBV infection. In this regard, it needs to be emphasized that we did not observe an association between vitamin D and HBsAg serum levels, suggesting that therapeutic administration of vitamin D alone may probably not promote the important clinical goal of HBsAg loss.

Our study has several limitations. Most important, clinical association studies cannot prove causal relationships. Thefore, a suggestive functional link between vitamin D metabolism and HBV replication remains elusive. Nevertheless, our study is of hypothesis-generating value for the design of future in vitro studies or prospective clinical interventional trials. Furthermore, the cohort investigated in our study is not representative for all phases of CHB. Especially, patients with advanced liver fibrosis and high ALT serum levels are underrepresented in our cohort. Furthermore, only few patients in our cohort were HBeAg positive. Although the majority of HBV patients treated in our center is HBeAg negative, the inclusion criterion “treatment-naïve state at time of vitamin D quantification” of our study appears to account for a selection of overall younger patients with limited degrees of liver fibrosis, as well as of HBeAg-negative patients. Yet, it appears unlikely that the profile of the present cohort affects the main finding of our study, that low 25(OH)D3 serum levels are associated with HBV DNA viral load. In addition, the number of patients in our study who received antiviral therapy after initial vitamin D quantification, and in whom vitamin D serum levels could be quantified during follow-up, appears to be too small to draw final conclusions. Although 25(OH)D3 serum levels were slightly higher during follow-up, compared to baseline, which may indicate that HBV replication affects vitamin D metabolism, this difference did not reach statistical significance. Larger studies are necessary to fully address this important question, as well as to assess the effect of other possible determinants of vitamin D serum levels, such as BMI.

In conclusion, we demonstrate a significant association between low 25(OH)D3 serum levels and high levels of HBV replication in chronically infected patients. Future studies to evaluate a therapeutic value of vitamin D and its analogs in HBV infection may be justified
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Avatar_f_tn
Stephen does this mean people with advanced fibrosis they should take care in taking vitamin D? How is related to fibrosis? Just curious!
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Avatar_m_tn
I have no idea, but I would certainly make sure I am not deficient in my vitamin D level.
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Avatar_m_tn
Stephen does this mean people with advanced fibrosis they should take care in taking vitamin D?

of course they must take it, and when damage is very very severe even 400.000iu of vit d3 rise vitd25oh few decimals, so it does not exist a dose anyone must test vitd25oh, ipth, calcium and find his dose (it is not like for healthy persons)

http://www.vitamindwiki.com/400%2C000+IU+barely+raised+liver+transplant+candidate+vitamin+D+levels+%28no+surprise%29+%E2%80%93+March+2015

here s ho wlow vitamin d can make liver inflammation, NAFLD

http://www.vitamindwiki.com/Liver+Inflammation+%28NAFLD%29+is+prevented+by+Vitamin+D+%E2%80%93+review+May+2015

but it is not only this, it is correlated to fibrosis directly, kidneys with 50% less function, fatty liver, insulin resistance, liver cancer.few researchers proposed low vit d as a marker for liver cancer sicne they found correlation with this too

http://www.vitamindwiki.com/Liver
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Avatar_f_tn
Thanks Stephen and stif, i do take 10,000iu of vit D3 daily though, i just want to make sure how it really affects the fibrosis.
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Avatar_m_tn
Royal36, this study that Stephen quoted dosent prove that vitamin d helps fibrosis.
It only shows associative relationship with hbv, but it's not proven that it's the cause to hbv or that taking it helps to clear the virus. There is not one study that proves that, only show associative relathship. You might as well take other supplements that have associative relathionship, dosent mean anything...

If I were you I would be more worried about the damage a big dose of vitamin (10,000iu) can cause to your kidneys.
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Avatar_m_tn
10.000iu of vit d is not a high dose, all hbvers must take vit d and must not have deficiency to stay healthy this is what we know for a fact.what is not proven is vit d to make damage there are only a few clinical cases taking millions of iu daily for over 6months and even in these few clinical cases there were no permanent damage.

italian guidelines for vitamin d deficiency prescribe 1million iu

http://www.vitamindwiki.com/How+often+might+50000+IU+vitamin+D+be+taken+-+results+of+clinical+trials

http://www.vitamindwiki.com/Vitamin+D+-+Facts+and+Myths

this said, dont take any vitamin d it is your choice
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Avatar_m_tn
https://www.researchgate.net/profile/Salvatore_Minisola/publication/221759661_Guidelines_on_prevention_and_treatment_of_vitamin_D_deficiency/links/0deec52cacdc1ef7a9000000.pdf

and 1million iu is not for sick patients but only for deficient patients
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Avatar_m_tn
i myself take 4.600.000iu of vit d3 per month, 150.000iu daily since 2 years and many others here take since long time and how can it make damage with the monitoring?



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Avatar_m_tn
http://www.vitamindwiki.com/Vitamin+D+toxicity+after+50,000+IU+daily+for+2+years+(no+surprise)+%E2%80%93+April+2015

Vitamin D toxicity after 50,000 IU daily for 2 years (no surprise) – April 2015
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Avatar_m_tn
http://www.vitamindwiki.com/Can+You+Overdose+on+Vitamin+D+-+It's+Harder+Than+You+Think

Can You Overdose on Vitamin D - It's Harder Than You Think
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Avatar_m_tn
http://www.vitamindwiki.com/56+suppliers+of+10000+IU+vitamin+D+%E2%80%93+yet+2000+IU+toxicity+claim+persists+Oct+2010

The 2000 IU toxicity scare got started in the 1950’s, was proven wrong in the 1960’s and has persisted now for over 50 years.

the problem is not too much but too little since toxicity is impossible by simply monitoring vitd25oh, ipth, calcium monthly
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Avatar_m_tn
vitamindwiki - seems like a propagnda site, that obviously not going to say anything against vitamin d. could be ran by the vitamin d companies. I rather have external objective sources that say something on vitamin d.

Again, not deficient is anything above 20, 20-30 is insufficent and above 30 is sufficient.... the people who seroconverted above where between 27-35, other than that I don't see what benefit you get from maxing your dose, you still haven't provided a single proof, not a memeber nor a study that proves how maxing vitamin d helps hbvers, and don't tell me the more damage there is the more you need to take... also you might say that you monitor your dose, but this is all short term... what about the long term effects of taking vitamin d? that's something to think about...
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Avatar_m_tn
that website collects all vit d studies, you read the abstract and if you want to see more than abstract you pay and follow the link to the published study

Again, not deficient is anything above 20, 20-30 is insufficient and above 30 is sufficient....

vitd25oh ranges is for healthy people only and it is supposed, some research center lab have range 30-150ng/ml because also 140ng/ml can be found on people exposed to sun  
vit d levels is not vitd25oh so you need ipth too to see how vit d is in our body.

and this is enough for me, do what you like, a part from vit d there s nothing can be suggested here without hbsag quant nothing can be done except take nucs when fibroscan gets high
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Avatar_m_tn
https://www.youtube.com/watch?v=hOfO29rL-gI
english subtitles

high dose vit d has been taken from the experience on treatment of multiple sclerosis and autoimmune diseases in a brasilian university hospital and it is thousands of patients for 10 years in brasil and thousands of patients in italy since 2 years (doctors in italy started about one year ago and some italian patient started protocol years ago in other european countries), no one had problems and of course all are monitored by doctors with tests every 4 to 6months (i check monthly for myslef)
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Avatar_m_tn
if "hbsag quant" was known, what kind of alternative to nucs there is to deal with it if at all?
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