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HBV DNA VERY LOW BUT ELEVATED ALTs
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HBV DNA VERY LOW BUT ELEVATED ALTs

Hi Stefano and others,

Woudl you start anti virals or wait and monitor  if the ALTs are elevated and average between 80-100 over two years but DNA is only 180 IU which came down from 11000 IU. HbeAg is neg.
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Avatar_m_tn
hbvdna low with elevated alt and medium/low hbsag means active immune response and this is the best moment to attack the virus with immune modulators drugs interferon and nitazoxanide, if this is the case i would not wait

to be 100% sure it is immune system and not fatty liver, overwhieght, visceral fat, bad diet, check hbsag level and ultrasound to exclude any fatty liver to make elevated alt

the best response with interferon is with vit d 50-60ng/ml, low cholesterol and normal glucose (lipids and sugars are used inside the cell to make hbsag so lowering these ones by drugs or supplements helps)
4 weeks pretreatment with nitazoxanide
1 year treatment with int+ntz keeping high vit d and low choles/glucose, if hbsag gets lowering it is better to continue until hbsag neg for more than 1 year (interf has been used 2-5 years until hbsag neg on those with lowering hbsag)
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Avatar_m_tn

interferon is a hard therapy but we beeter attack now because we dont know how long the virus will stay under immune attack.these up and down with immune pressure are due to hbv mutations when immune pressure is too much it can mutate and return to higher hbvdna levels

of course hbsag quantification by architect is a must to understand if this therapy works, if there is no hbsag lowering in 6 months it is better to stop interferon and wait for better drugs
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Avatar_m_tn
you are right but as you said Intf is very hard and side affects are heavy.

unfortunately Hbsag quanitative by abbot is available in UK, if you have any knowledge then please share.

I know from Ultrasound that the liver is fatty but I am not over weight at all.
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Avatar_m_tn

fatty liver is presnet even in low whight, it is made by hbv not by diet or over wheight most of the time.hbv changes cellular instructions to make more cholesterol and glucose available by making cells resistant to insulin.latest research has shown that decreasing cellular cholesterol hbv lose infectivity, replication and lower hbsag production
also diabetes 2 drugs have antiviral effects and regression of hcc in vitro, insulin also lowers hbsag production
simvastatin, lovastatin lowers hbsag too

since bmi higher than 23 makes less response to nitazoxanide, interferon and weaken immune system i am making bmi and wheight low by exserise.fatty liver increases interferon sides too
i am increasing insulin sensitivity by vit d, vit E, fish oil, once i reach optimum levels i am planning to try red yeast rice to lower cholesterol and bitter melon tea (momordica charantia) which is reported more potent than diabetes 2 drugs with no sides

i suggest you do the same to prepare for interferon lambda which has no sides or nitazoxanide therapy, but i'd give a try to interferon because on young and low bmi sometimes it has no sides at all.for example my sister had only some tireness and mental confusion for studying when she did it
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Avatar_m_tn

as to UK i've seen healthcare and if you dont find a fibroscan or hbsag quantification it is much easier to take inexpensive ryanair to germany/france or italy.

i know in italy you have everything free because when i was in uk it was the same because of exachange between our healthcare systems, in italy you will find both in every region/big cities but pisa (where i go) is very god because there are no crowds and everything is easy and fast
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Avatar_m_tn

as to interferon lambda it is on trial on hbeag positive in italy, i ve been told that it is about 2 years from being available but i guess in US/italy.
i have noticed UK is very slow on expensive drugs, i ve seen reports they delay entecavir by UK healthcare because too expensive, so interferon lambda might take very long there

do you have biopsies about liver damage?

if no liver damage options are: getting rid of fatty liver, red yeast rice and the tea i said above to improve lipids and weaken the virus, vitamin d to optimum levels 50-60ng/ml, use of ntz and see if that's enough to lower hbvdna/hbsag
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Avatar_m_tn
http://www.medhelp.org/user_journals/show/218544/INSULIN-RESISTANCE-INFORMATION

found this on hcv forum and it applies quite well to hbv too, both viruses act the same way as regards lipids/sugars but hcv is much heavier than hbv making insulin resistance/fatty liver and steaotosis but if we find this on hbv we better work to get rid of it both before interferon/ntz therapy or even if we stay out of therapy

it is not easy to determine if we have insulin resistance but if fatty liver is present we have it, insulin resistance might also end up with diabetes 2 with many years
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Avatar_m_tn
http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/waist-circumference.php

best bmi lower than 24 but for us hbvers lower than 23 is even better and waist men much less than 94cm and women much less than 80cm

i thought to be ok with bmi 24 and waist 100-104cm but that is not the case at all, especially with hbv
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Avatar_m_tn
Hi Stefano,

Thanks very much for taking trouble to write so much. I have checked my BMI which is 23.5. waist is less than 90 cm.

No biopsies result as never had one. Only had ultrasound.

can we just Fly to Italy and have fibroscan/ HbSag quantitative done?? I mean are you saying there is no need to register with GP first like here in UK?
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Avatar_m_tn
check here for strangers in italy and healthcare (the part translated in english is at the end):
http://www.asl4.liguria.it/ovinternet/Resource/Doc/info_stranieri.pdf

brunetto in cisanello hospital in pisa and lampertico in ospedale maggiore are the best researchers in italy (and among the best in the world).my choice was pisa because smaller, easier to reach from airport and ryanair getting to pisa.

they have a own separate laboratory for blood tests and fibroscan and ultrasond machines are directly in the day hospital rooms and routine visit is blood test/ultrasound+fibroscan together
so when you go there you have a full check up (blood/body) within a couple of hours (they always book hours for both blood test, visit and fibroscan/ultrasound is made by the same doctor who makes the visit).
it is possible to do blood tests in the main laboratory of the hospital without booking but you get long queques and might get hbsag without diluition with result hbsag>250iu/ml which is useless for us

brunetto team is made mainly by international italian researchers so they all speak fluent english (secreataries when you book might not).

i guess it is easier to call the hospital directly and get to know how to book blood test/visit/fibroscan with one of brunetto team doctors, i do suggest dr.colombatto.he also makes payment visits in the same hospital in the evening

if you find it difficult i can call the hospital and ask them what you certificates you need to book and come here free or very low price.
i guess it is normal to come here instead of england to have visits especially if fibroscans and hbsag architet is not available in england

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Avatar_m_tn

you can also have the tests for your genotype, precore/bcp mutants and polimerase mutations.these are available only in the research centers here in italy, they take about a month but are very very important to choose if treatment is necessary and which drugs are ok
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Avatar_m_tn
I have checked my BMI which is 23.5. waist is less than 90 cm.

you are perfectly fit
i have started 20 th jan being bmi 25 and waist about 104cm (bmi 25 is still conisdered normal but i believe that is wrong on particular populations like us)

now bmi 23 and waist about 94.

my ideal is get to bmi 22 and waist less than 90 especially because i saw a research of interferon response and weight with best results in the range 60-70kg irrispective of bmi because those bodies could keep high interferon blood levels of people with higher/ower weight

i also saw a post of an italin a girl very low weight, 166cm X 46kg, absolutely low weight, but she got rid of hcv by the second interferon shot.....actually maybe hcv left because there was nothing to eat there
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Avatar_m_tn
thats great!

I am going to see my Doc here on 08 March. I shall then contact you and you can guide me to make appnt for fibroscan/ Genotype tests and Hbsag quantitative test.
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Avatar_m_tn
UPDATE from yesterday's Appointment

ALT - still high 89

HBV- DNA 531 IU

Doc is unsure of the fact that raised ALT are due to fatty liver or HBV. monitring over six months but will probably ask for Biopsy which I dont't want. They want to find out the quantity of fat in the liver cells.  

Fatty liver itself coudl be due to HBV or genetical.

Look forward to your advice..
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Avatar_m_tn
Fatty liver itself coudl be due to HBV or genetical.
due to hbv and lifestyle but the main common thing on all fatty liver cases even with bmi 19 is insulin resistance

i am now bmi 22 and weight 71kg (still losing 1kg per week), my body is getting like when i was very young with no fat tissues visible

since i have used exnical and many things to lose weight even swimming 2hrs every day and never reached less than 74kg, the main reason is suppression of insulin resistance and elimination of fat tissues by:
blueberries plus berries fruti mixed minimum 170gr daily, blackrise daily instead of pasta at lunch and dinner, this has been reported by studies to lower fatty liver in me it is reversing all fat tissues to none
omega3 fish oil 4,5g, vitamin d 4000iu every day and sunbed 3 times a week, vitamin e 800iu daily
i take also to prevent any kidneys tox:
coq10 280mg daily, nac 2000mg daily

try exactly the same things as me plus some gym or excercise and see what happens to alt
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Avatar_m_tn
Doc is unsure if raised ALTs are due to fatty liver or HBV. They want to do liver biopsy to see the quantity of fat in the liver. In UK, tehy still do liver biopsy before putting you on antivirals. I obviously dont want the liver biopsy. The doc said Fibroscan is good to check the fibrosis only but the fat can only be quantified by biopsy. How true?

I would rather travel to Italy to get fibroscan and HASAg quantitative done. UK is far backward with regards to HBV. they are just not intesrested as it is of no concern to them as the prevailing rate is too low..

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Avatar_m_tn
How true?

yes the severity of fat can be quantified by biopsy only but if you have fat or no fat is detected by ultrasound it just cannot tell the severity...so if fat is present you have to do something about it anyway

as to the virus a very high sensitivity hbvdna pcr can rule with very high probability if it is the virrus increasing alt.

fibroscan detects whatever can make liver stiff so both fibrosis, inflammation and fat tissue.if i were you i'd check both fibroscan, ultrasound and hbvdna pcr (sensibility 6iu/ml)

they are just not intesrested as it is of no concern to them as the prevailing rate is too low..
i think they are scared to know how many destroied livers by alcholl are present around the country...germany made a free fibroscan touring bus for this so they can detect all the damaged livers due to unhealthy diet/alcool

i agree with you as to the fibroscan done in italy because i don t like biopsies too, i had two in my life and i felt weaker and lost tones of hair when they did it
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