Me and My HBV Story

[melcul]

I am a 25 years old European Male .

On 03.06.2014 i have discovered on a routine blood test that my ALT were 86.7 U/L [5-41]that way i discovered i am HbsAg Positive
Did Ultrasound on 07/2015 , everything was ok, besides some sand on my kidneys .

AST : Always in range

ALT History :
13.06.2014 : 111 U/L
09.07.2014 : 79 U/L
14.07.2014 : 92 U/L
13.08.2014 : 63 U/L
01.09.2014  :50 U/L
26.09.2014 : 81 U/L
13.10.2014 : 72 U/L
10.03.2015 : 74 U/L
02.06.2015 : 120 U/L
31.08.2015 : 59 U/L


HBVDNA History :

23.07.2014 :  > 170.000.000 UI/mL
26.03.2015: 1.5 billions


HbsAG:

26.09.2014 : HBSAG quant : 350k
26.03.2015 : dropped from 350k to 220k

HBeAG : Positive
HbeAb : Negative
HDV : Negative
VDRL  : Negative
HIV 1+2 : Negative


March 2015
Fibromax F0
Fibrotest : Score: 0.17(F0)  [0-1]
ActiTest : Score: 0.40(A1-A2)  [0-1]
Steatotest : Score: 0.34(S0-S1)  [0-1]
NashTest : Score : 0.25(N0) [0-1]

I had 2 Fibroscans at 2 different hospitals :
First fibroscan F2; second fibroscan f0 (1 week difference)

22.01.2015 :
Fibroscan Reading F2 7.2 Kp Again .

[Nmarius]

Question: is there a problem to start with ETV then switch to peg-INF?

[melcul]

this is what my doctor wanted because i had a high hbvdna, but my insurance doesn't cover this kind of treatment

[lila58]

You have a good chance to be genotype A which responds better to interferon,you are young,don't be afraid and go for it.I missed that when I was younger,because nobody recommended,now I am too old for this.

[Aduiski]

i would also suggest as steff. Check your genotype (if A than a good chance to clear on peginf) and kidney tests. If non A genotype and kidney test fine then TDF seems like a good choice to start with with peginf add/switch later.

[melcul]

Never done or asked to do genotype, don't have hbsag q, doctors here don't ask for that. I will do it myself as before. I am now waiting to my doctors appointment in half an hour. I am afraid to start interferon if i have f2 but i am also confused that fibroscan came last time f0 then f2 ,f0, f2 . Either entecavir ..safisifa had some luck, i am in his exact sitution without his f3 fibrosis... Who knows. Keep you guys posted.

[sorte]

You sure fibroscan was made by the same person and during  similar ALT values ?

[melcul]

The same person, which seems to have a hard time trying to hit the right spot. But the fibroscan result shiw success . I just finished consulting with my doctor. So i will start treatment after my the insurance will approve , may be around 2 months.doctor first wanted to give me nucs for a few months because of high hbvdna then add interferon but this method was not approved by our insurance . So he strongly reccomend to start interferon. My only fear is that because of high hbvdna, my alt not to spike beyond dangerous levels and destroy my liver. He said it's not a problem, and that he will stop it if alt goes above 8x normal range. At the moment, the easiest way would be nucs, but thus will be on long term. On the other hand, interferon may also help and would just be for an year . Though choice

[antistr]

i would choose interferon if these are the only options.if doc says ok i think there is nothing to be afraid of.you are young and will lose nothing for trying interferon.you can always fall back to nucs if things do not go as expected.

[stef2011]

do you have any hbsag quant and genotype?according to the levels/genotype i would go for tdf and then peg add on or switch

i think that being hbeag positive the chances to cure hbv starting therapy before precore bcp mutants are much better, of course the cure takes a decade or two but hbsag decline may be easier than viruses like mine which had a lot of immune attack and mutations, nevertheless i also managed to lower hbsag a lot

[melcul]

My entire blood test results came back .
ALT : 74 [5-41]
AST : 29 [5-38]
Cholesterol: 213 [120-200]
triglycerides: 159[35-150]
HBVDNA: >170.000.000
complete blood count [everything in range]
Prothrombin time: [everything in range]
AFP: 2 [0.5 - 5.5]
HbeAB negative
HbeAG positive
HDV Antibody : Negative
Fibroscan, this time came f2 (7.4KP)

With diet i managed to lower my triglycerides from 230 to 159, cholesterol is still above the limit, but it will go down soon, i hope.

with this results i will have to choose this month between Interferon, Entecavir and Tenofovir.

[Liverpatient]

Yes, as others are saying, you need to start with peg-interferon. You are young, and because you are still hbeag positive, this means your hbv has not mutated. Therfore, you have a better response chance to peg-interferon treatment for 48 weeks.
If the interferon helps, which I hope it would, it is good, otherwise you can still switch to nucs like entecavir, tdf, or taf.

[Aduiski]

Yes, even though it is unusual for your age to have that high cholesterol, so probably genetics contributed to that and you'll have to pay special attention to it and be more careful regarding it then an average person so that you don't develop heart disease, diabetes and reduce your liver fat.

Keep a good diet with lots of daily natural/organic fruits and vegetables.
Avoid sugars and saturated fat! Avoid diary products unless they are very fat-reduced products, pay special attention to fat in meat (avoid it like plague). Fish is the healthiest meat, chicken is generally healthier then red meat, totally avoid pork meat.

Start with regular exercise (and once you muscles adjust to it keep exercising on at least 5 days per week for at least 30-40 minutes per day in a way that your significantly notice your breading. Walking is not sufficient...go for running or swimming).

[melcul]

like all young man here , i never had a problem in my life regarding health, so i never cared what i eat or do, so that was the problem .Since i discovered it i have changed my lifestyle but you need a very strong will to do that, i still eat from time to time junk food...i hope i can avoid that and any kind of sugar related  in the near future .

[Aduiski]

Just noticed your triglycerides and cholesterol results.
You really must take care of your food and exercise from now on because of a number of things including liver, heart and diabetes/kidneys.

[melcul]

i am 25 . the doctor delayed me for 6 months since i have discovered, that's the procedure here, to be sure it's not acute .than he delayed me another 6 months to see if alt goes down (thinking it can be in the imune phase and blaming the Fatty liver . and of course, like there wasn't enough going on with me, i had some problems in my personal life and had to take care of that . Now i'm aiming to start treatment i hope next month after the results are back

[Aduiski]

Yes you waited too much.

How old are you?

Post your newest results when you have them as you don't have any recent results if I am reading correctly your post.
Do blood test and ultrasound of your kidneys to see their current state as that might influence the decision of your choice of Hep B treatment, especially as you had some "sand" on your previous ultrasound.

In any case you shall keep very healthy diet AND start exercising right away...and exercise regularly, in order to:
a) loose weight and keep the fat out of your liver (you don't want to have fat in your liver as fat itself is damaging the liver, especially as you have hep B)
b) not develop diabetes (diabetes damages kidneys and ultimately liver), tenofovir might not be the best choice if your kidneys are not good.

[melcul]

I also had some fatty liver all this time, with my triglycerides : 225.8 mg/dL and cholesterol 220 mg/dL initially .

Now, i have changed my diet, of course, try to eat healthy as much as i can .
i have delayed the treatment for a few months, my doctor told me i had to chose what to do in November but i had some problems and had to delay the consult to this month . I only did my fibroscan which came f2 7.6 kp ( i typed wrong 7.2 kp in the initial post, but that can be from ALT or fatty liver,
i had it in the past and gone back to f0 pretty quick .
( my height is 170 cm and i have 76 kg. )

Please advice me what to do next . My Doctor recommends me to start with Interferon because i am young and he aims to make the virus Inactive so i save some time before starting with nucs .
I did not had a normal alt all this time, was kind of higher than normal ..
It is very difficult to chose a proper treatment because it seems like all i would chose i could've done something better or i may be wrong .

The entire blood test results will come at the end of this month and i can't wait much longer, i feel i have waited long enough anyway .