First post.

[japonego]

Hello,
First of all thanks for this forum, it is very useful and helpful.
I did some blood test which went out like this:
(all abbot axsym method)
HBsAg positive 166,20
Anti HBc positive 0,08
HBeAg posiive 323,69
Anti HBcM positive 1,86
I know that I would need some other results to observ the virus behavior but I was lead to a doctor, wich only with these results gave a one year treatment with tenofovir.
So then I decide to move to a second opinion. I´ve got appointment next thursday and probably will be doing other blood test by friday morning. But till there I want to know if I´m in a acutis or chronic infection. I´m very concerned and doing lots of research on internet.


thanks and best regards for all.

japonego

[stef2011]

ok you made the right choice.if you didn t take tenofovir for one year and that is first test, i got it wrong,

you are probably acute and close to clearing infection since hbsab already detactable and hbcab igm positive, if hbv just started it is 100% acute now
do not take any drug, just take good rest and live healthy until hbsag will clear.guidelines require drugs only in case of liver failure during acute, by the way make also a liver function test just for extra security

the other doc should have licence removed, he made evrything wrong esecially because i see you are only 27yo and tenofovir might be useless even if you were cronic at this early stage

is anti HBcm = hbcac Igm ?
it is not written correctly but it can be only it, do check for hbsab, hbvdna pcr and hbeab

[japonego]

* so I did not take tenofovir!

[japonego]

hello stefano,
those are my lab tests. actually my first hbv test ever.
I went to a first doctor which didn´t ask for any other tests and gave me tenofovir after a 15 min chat. I was kind of afraid and went to a new doctor, in a bettter hospital. So then I made some new lab test which I´m waiting for. I already know my high results ALT 328 AST 142.
But I´m waiting for the others.
so for now this is my lab tests:
HBsAg positive 166,20
Anti HBc positive 0,08
HBeAg posiive 323,69
Anti HBcM positive 1,86
ALT 328
AST 142

is anti HBcm = hbcac Igm ?



thanks

[stef2011]

no positive hbcab Igm during cronic hbv means an activation of immune system, it is seen in two cases:
before hbsab appears for hbsag seroconversion but it is not really hbcab igm but a different antibody that makes this test positive anyway
and the other occasion is when resistance happens and there is reactivation of infection.if you monitor both hbvdna and hbcab igm you have maximum sensibility in detecting resistance

he needs to check hbvdna and all others parameters but he is definitely cronic especially because he is taking tenofovir and virus is still there, if you take an antiviral during acute you'd clear infection quite fast since the virus would get ultra weak

[japonego]

hey cajim, thanks for the answer. but don´t you think that positive for antiHBcM is an evidence to an early infection?

[cajim]

You would be chronic if you had two tests 6 months apart both showing HBsAg+

You show HBeAg+.  You may have high HBVDNA with little or no liver damage.

Are you taking the conventional, Western-medicine route or some other route?

If the former, according to AASLD Hep-B Guideline 2009 Update,

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT 40 years, ALT persistently high normal-2x ULN, or with family history of HCC.  Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, observe for 3-6 months and treat if no spontaneous HBeAg loss.  Consider liver biopsy prior to treatment if compensated.  Immediate treatment if icteric or clinical decompensation.  IFNa/pegIFNa, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  ADV not preferred due to weak antiviral activity and high rate of resistance after 1st year.  LAM and LdT not preferred due to high rate of drug resistance.  End-point of treatment – Seroconversion from HBeAg to anti-HBe.  Duration of therapy: IFN-a: 16 weeks;  PegIFN-a: 48 weeks;  LAM/ADV/ETV/LdT/TDF: minimum 1 year, continue for at least 6 months after HBeAg seroconversion; IFNa non-responders / contraindications to IFNa -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, IFN-a/peg IFN-a, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance  ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  End-point of treatment – not defined.  Duration of therapy:  IFN-a/pegIFN-a: 1 year; LAM/ADV/ETV/LdT/TDF: >1 year; IFNa non-responders / contraindications to IFN-a -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >2,000 IU/mL ALT 1- >2 x ULN, then, consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.

If you are HBeAg-, HBV DNA (PCR) <=2,000 IU/mL ALT 2,000 IU/mL—Treat, LAM/ADV/ETV/LdT/TDF may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance; ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  HBV DNA6 months; 2. Serum HBV DNA >20,000 IU/mL (105copies/mL), lower values 2,000- 20,000 IU/mL (104-105 copies/mL) are often seen in HBeAg-negative chronic hepatitis B; 3. Persistent or intermittent elevation in ALT/AST levels; 4. Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation.

Inactive HBsAg carrier state: 1. HBsAg-positive >6 months; 2. HBeAg-, anti-HBe+; 3. Serum HBV DNA 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 ULN, or who remain HBeAg positive with HBV DNA levels >20,000 IU/mL and are >40 years old, should be considered for liver biopsy, and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis. Patients who remain HBeAg positive with HBVDNA levels>20,000 IU/mL after a 3-6 month period of elevated ALT levels >2  ULN should be considered for treatment.
HBeAg- patients:
● HBeAg-negative patients with normal ALT and HBV DNA <2,000 IU/mL should be tested for ALT every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months.
● Tests for HBV DNA and more frequent monitoring should be performed if ALT or AST increases above the normal limit.

Side effects:

IFN-a and PegIFN-a:  initial influenza-like illness: fever, chills, headache, malaise and myalgia. Other common side effects include fatigue, anorexia, weight loss and mild increase in hair loss. The most troublesome side effect of IFN-a is emotional lability: anxiety, irritability, depression and even suicidal tendency.

Lamivudine:  very well tolerated.

Adefovir Dipivoxil (bis-POM PMEA, Hepsera):  Nephrotoxicity has been reported in 3% of patients with compensated liver disease after 4-5 years of continued adefovir therapy.

Entecavir:  a similar safety profile as lamivudine in clinical trials.  Studies in rodents exposed to doses 3 to 40 times that in humans found an increased incidence of lung adenomas, brain gliomas and HCCs.

L-deoxythymidine (Telbivudine/LdT, Tyzeka):  well tolerated when used as monotherapy and has a safety profile comparable to lamivudine.   However, cases of myopathy and peripheral neuropathy have been reported.

Tenofovir:  has been reported to cause Fanconi syndrome, renal insufficiency as well as osteomalacia and decrease in bone density.