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

[itac]

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!

[itac]

if "hbsag quant" was known, what kind of alternative to nucs there is to deal with it if at all?

[stef2011]

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)

[stef2011]

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

[itac]

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...

[stef2011]

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

[stef2011]

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

[stef2011]

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

[stef2011]

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?

[stef2011]

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

[stef2011]

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

[itac]

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.

[Royal36]

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.

[stef2011]

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

[StephenCastlecrag]

I have no idea, but I would certainly make sure I am not deficient in my vitamin D level.

[Royal36]

Stephen does this mean people with advanced fibrosis they should take care in taking vitamin D? How is related to fibrosis? Just curious!

[StephenCastlecrag]

"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

[flyinsky]

I am against big quantity personally take it just when there is luck after blood test

[flyinsky]

I am against big quantity personally take it just when there is luck after blood test

[sorte]

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.

[itac]

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...

[itac]

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...

[flyinsky]

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.

[Royal36]

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.

[itac]

"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.