HB e antigen +, Korean born female

[NoniAva]

Hello,
I am a 30 yr adoptee Korean born female that was diagnosed in 99 while pregnant with my first child as chronic active HB e antigen+, e AB - HBsAG+, HBsAB equivocal + (antibody present but below immunity threshold), HBcAB+, ALT 40, AST 17 and HB DNA viral load at 1 million. Hepatologist at that time told me I most likely contracted it at birth. Husband and two children all immunized and I had tubal ligation after 2nd child in 2003. 2004, I had liver biopsy that only revealed moderate portal inflammation, no increase sustainable iron, no significant fibrosis and focally positive immunostains against hep b surface and core antigens, HB DNA viral load of almost 9 1/2 million. Dr believed that I was in immune tolerant phase, therefore I would have low response to antivirals. From then until now, life has been busy, unfortunately I wasn't able to followup until now. I currently am pending screening phase for clinical trial testing Pegylated Interferon Lamda. I just had CMP panel drawn and am worried that liver enzymes will be too high. The only new symptoms I have are yellow stool, edema of ankles and feet, nausea, low grade fever of 99.9 and shortness of breath, dry mouth and I feel like I'm full and not very hungry. I've only had these new symptoms for past week but have always had body pain/aches since I was a child. Clinical trial can only treat if I am not cirrhotic and I am worried that I have already progressed into immune clearance phase and well into compensated liver. My question is what is my percentage of already having transitioned and well into compensated liver. Also, to qualify, my ALT must be at least 45 and I am unsure of how those progress over time. Could you also tell me what now is the upper normal levels for both AST and ALT? Also now that I'm 30, should I expect transition into immune clearance phase soon, if not already? Thank you for your expertise.

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[stef2011]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

in this case if bad sides happen it is alpha, especially neurological and lowering on immune system because lambda doesnt touch these rogans

hbcab is in s/co

[4est]

I think that in this trial will not be any placebo, only PegIFNa-2a - like active comparator and   pegIFNA.

what is the unit measure for hbcab igm quantity? (as | understood "s/co" it is representing the reactivity level or I'm wrong ?)

[stef2011]

if you post or send by pm the tests after a couple of weeks i can tell you almost for sure if it is placebo, especially if you have baseline tests before starting

if you do get lambda make sure to follow my suggestions to make the best out of it and once 48weeks are finished, if hbsag is still there but getting down, start interferon alpha because 1 year usually makes only 11% clearing hbv and if you stop it was all almost useless

trials are of course for drug makers benefit, not patients, but knowing what you doing you can get the most of it

starting with baseline vit d, chol like i said increase chances very very much.vit d level alone without treatment has inverse correlation with hbvdna...

adding alinia, which is a babies drug, allowed even on 1year olds, can make interferon a bomb.we have had some comboing and it increases interferon pathways.much of the trials were on hcv but this is not important.many of us are combo with antivirals but it has very little effect with antivirals

at the end you can combo another year with int alpha and alinia or add entecavir or tenofovir too.interferon alpha rates a 2 years combo with lamivudine have more than 30-35% hbv clearance...lamivudine is the weakest useless hbv drug so using etv or tnf and alinia will make the rates much higher

interferon+tenofovir+ftc has been used on hbv+hdv coinfections clearing both viruses in 11 months
interferon+entecavir+tenofovir has been used also making hbv clearance to previous non responder to interferonmonotherapy

[stef2011]

hbvdna alone has no meaning at all, you have to see it with hbsag quant, fibroscan, alt/ast to know what it means

also hbcab igm quantity can help, 0.2s/co active immune system.also this test must be considered together with all ohters

a very high hbsag>50000-100000iu/ml is surely immune tollerant too

but anyway abnormal alt with hbvdna in the millions and some fibrosis without fatty liver is active immune system

[stef2011]

make also sure to have:
tot chol less than 150mg/dl
ldl60mg/dl

this messed up while posting, the correct values are:
tot chol<150
ldl60

off course these values are very low but even getting close is ok

[4est]

Good luck on your trial.
if you ware in immune tolerant phase, couple of year ago, i don't think that you evaluated to compensated liver. Immune tolerant phase is  characterized by no liver damage do to the virus, immune system and virus ignore and do no harm to the liver.
Anyway, also pegINFA alfa and lamda are good as tratament option, even if about the lamda i only read only few information I had the impression that is looking to be superior to the alfa and had no no serious side effects, so good luck to the trial and get a  lamda and if is possible please share with us the information (results, or side effects ....)

[NoniAva]

Study is for CHB e -antigen positive patients.
This study is a blinded study, 1:1 chance in getting 180 mg PegIFNa-2a or 180 mg pegIFNA for duration of 48 wks. 1 subcutaneous injection per wk. I'm going through Atlanta Gastroenterology Associates headed by Dr. Norman Gitlin.  

[NoniAva]

Thank you for your response.  I will find out tomorrow if I have qualifying ALT's so that I may go onto the next screening of tests including biopsy.  The doctor is a little concerned that I maybe well into compensated liver by now and that would be another disqualifying factor.  I do hope for this treatment especially because it's half the side effects.  What's your thought on 9.5 million on DNA viral load in 2004 (huge jump from 2002)?
Thanks again

[stef2011]

if possible report to the community improvments from interferon lambda, many of us are waiting for it and use comboed with other antivirals since interferon alpha has too many sides and using it for too many years is heavy

what now is the upper normal levels for both AST and ALT?

ast is not important, alt is 19 for women and 30 for men.in trials there is little scientific and everything is just changed according to what fit best to the drug producer so they might be using the very old normal alt at 35 or 40

fibroscan will tell you immediately how your liver is although US dont have it.a very big suggestion do check your health you can t keep cronic hbv infection for years without any monitoring, here is medhelp health pages with all the tests needed to monitor, these are the most updated althoug US is missing the mos timportant tests:

http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153

[stef2011]

I currently am pending screening phase for clinical trial testing Pegylated Interferon Lamda.

do try it, start supplementing vitamin d3 as soon as possible so that when you start  interferon vit d25oh is higher than 50ng/ml possibly closer to 100ng/ml.the best dose is from 5000 to 10000iu daily of vitamin d3 and check to see increase by 2 months

make also sure to have:
tot chol less than 150mg/dl
ldl60mg/dl

if you have higher cho you can achieve this by simvastatin drug or by supplements like red yeast rice, liposomal glutathione from livonlabs and pantethine

these baseline parameters increase the possibility to clear hbv on interferon very very much

i also suggest to use alinia without telling anything, you can find a generic called nizonide500 at lupin distributors pharmacies.alinia will also increase chances to clear hbv dramatically....using interferon is uselful only to clear hbv