HBV DNA detected again after stopping Baraclude

[ggtm]

I took Baraclude for 3 yrs 3mths and seroconverted to HBe neg/anti-HBe pos. and dna was undetected for about 2yrs. I recently stopped in March. But my recent lab results showed the dna is detected again.

March '12 - Stop baraclude
June '12 - hbv dna 1260 IU/ml
July '12 - hbv dna 966 IU/ml, ALT - 10

My dr said my levels are stable but may also cause liver damage over time. He mentioned the virus in my body belongs to the pre-core or core-promoter mutation group. And he also recommended me to take lab tests every month to monitor.

I wish to know what does "pre-core" or "core-promoter" group mean? What are the repercussions?

Does low hbv dna mean a lower risk of liver cancer?

What should i next do to improve my condition? continue to be on medication? or am I ok to stop and just monitor first. I am thinking of a natural treatment like taking phyllanthus niruri and thymus gland supplement. Anyone knows if it will help?

Appreciate your knowledge here...tks.

[ggtm]

Stef, can I get your opinion on this? Now that I am not taking entecavir anymore, but hbv DNA is still detected. What can I do/take to make DNA undetected again? Will u recommend alinia mono therapy? Since alinia has no sides, I don't mind to take it.  Feels kinda weird not taking anything...it's ironic I know.

[brej]

can you teach us on how you prepare the phyllanthus niruri... we have this herb in our place which you can see everywhere... did you boiled it and drink or taking it as a salad?

I also taking USANA Hepasil DTX which have a milk thistle, turmeric extract and sylimarin which help liver function... I have plan to shift medication to alternative medicine which deals with herbs if Beraclude did not work for me... Thanks

[brej]

what did you do while taking beraclude... your results is amazing... I have a HBV DNA load of 70,000,00 plus and now 4 months taking this meds and im not yet undergo a blood chem since is to expensive i rather buy beraclude to continue my medication... can you give me advice on what you do while taking this meds... thanks I'll wait your reply

[stef2011]

pure melatonin 20mg daily before going to sleep can increase wbc but it is not important if they are in normal range
dont look at immune system numbers too much, it is more important the quality of immune response than the number of immune cells around

vit d is essential for hbvers, another stupid ignorant doctor just bothered to prescribe or not prescribe.....

[ggtm]

I will try to do a vit d test elsewhere. This gastro I'm seeing doesnt think much of a vit d test and says it's not impt.

ALT 12
AST 15
Bilirubin total 0.8
Platelet count 307,000
WBC count 5800 (how to increase this? Noticed it's a bit low. Ref range is 3800-10800/uL)

For the moment, I will not get pregnant. I agree with veteranB. Health is more impt. Pregnancy can be postponed. I will try to see if I can get a Hbsag quant test done somewhere. meantime, I will monitor for the next few months and see if everything is stable first. Do you think I should do blood work again in a month's time? Or what is the frequency I should monitor now? I am afraid of a "flare".

Thanks very much for your knowledgeable advices. I have really learnt a lot from u guys and really appreciate it. I will pray that God will facilitate the process of hepB cures and lauch them ASAP! God bless!

SO this Quest Diagnostics can be trusted as accurate lab readings?

[veteranB]

Don't you think it is better to treat HBV before thinking of getting pregnant? I think it is better to get once life together in order first regarding health.

Of course you cant use any of these heavy drugs when one is pregnant.. that is a given..

[stef2011]

i agree too dont take drugs, keep going with vitamins and make serum vit d25oh superior to 50ng/ml and keep going with vit E too and let us know

how about ast/alt?hbsag quant not available?

after pregnancy i  d go with intf if hbsag is not too high

one thing to keep in mind pregnancy will elevate nagalase to suppress your immune system to protect the fetus, this may change immune balance with hbv, we will see this after pregnancy

[StephenCastlecrag]

In no way should you be treated with Interferon if are planning to have a baby. because Interferon is contraindicated for pregnancy. Treatment is usually recommended if your viral load is > 2000 iu/ml (over 10,000 copies /ml) and ALT >  1 x ULN, but this is not relevant in you case as you are planning to have another baby.

Vertical transmission increases for women with very high viral load (> 10^7 iu/ml) even if the standard HBIG and 3-dose vaccine are administrated within 12 hr our birth. So some doctors would consider treatment in the third trimester for women with such high viral load.

So, look like you have successfully stopped Entecavir. You should continue monitoring in the event of a relapse, hopefully it will last for a long time. During pregnancy, however, the immune system is suppressed against potential antigens expressed by the fetus (LOL), so it is possible that your Hepatitis may re-activate during your pregnancy. Of course, your immune system will be restored after birth, so there is no need to rush to treatment. You should always consider your liver specialist and the ob/gyn.

Just my opinion.

[veteranB]

Here is the test that checks for mutations http://www.specialtylabs.com/tests/details.asp?id=10529

Your DNA is low which is great. They usually put people on treatment with DNA above 1000 copies..

Stefano may explain better the link between vitamin D and antiviral activity. But we know that higher vitamin D doses have antiviral effect. So keep monitoring your DNA because it does fluctuate..

Other way of doing it is maybe put you on interferon and see if you can clear HBV..it will be a sequential treatment for you since your body seems to have some control of the virus.

[ggtm]

Hi guys, I need your advise here. I took another set of bld work last week and here are the results.

History:
March '12 - Stop baraclude
June '12 - hbv dna 1260 IU/ml
July '12 - hbv dna 966 IU/ml, ALT - 10
August '12 - hbv dna 7500 IU/ml, ALT - 12 (note this was done after my miscarraige operation end July. Not sure if there's any correlation)

October '12 - hbv dna 113 IU/ml (reference range <20IU/ml), ALT - 12, AFP - 0.8, all other results in the comprehensive metabolic panel are within normal range (too many to list here), liver ultrasound normal.

The lab report stated that this test was performed using the COBAS(R) AmpliPrep/COBAS(R) Taqman(R) HBV Test, v2.0 (Roche Molecular Systems, Inc.)
Performing site: Quest Diagnostics

Want to know is this result accurate? If so, why the sudden drop in hbv dna after 2 mths? I am still off medication. The only thing I did was to take vit D 5000IU, vit E 400IU andvit C 1000mg daily. Oh, and I also did chinese accupunture weekly (but that was done because I wanted to strengthen my uterus after my miscarraige. accupunturist said my "qi" was weak)

my gastroenterologist dr didnt want to put me on tenofovir. said will see me in 6mths?? I told him thats too long and he then said ok 4mths. I was actually thinking every mth! He has no knowledge of fibroscan, oxidative stress test and he still can tell me that he has consulted several other drs abt my case and all said not to treat. How? Is it safe for me to continue like that? happy with my results but worried at the same time too.

[ggtm]

You are a lucky mom! May I ask if you were on any meds before pregnancy? And were you all along HBeag neg, I presume?

My stand is not to be on meds untill I see a "flare", which I suppose is an elevated ALT. If this happens before I am pregnant, then I will start tenofovir. But hopefully, it won't, or can delay till at least 2nd trimester, where I'll be more comfortable taking meds. I am really praying all goes well..as I am one paranoid person.

[ggtm]

What do you mean when you say hbv dna is not impt to see infected cells, and ALT/AST not impt to see liver damage? I thought there's a corelation between hbv dna and progression to liver damage/cancer? And ALT tells if liver is inflammed or not?

[calmama]

Yes, I am a mother of 2 children.  But I didn't have your dilemma when I was pregnant because my viral load was undetectable and liver enzymes were very normal.

I agree with StephenCastlecrag's advice about getting third, fourth,....etc. opinions until you find a good hepatologist you are comfortable with.

Although Tenofovir wasn't approved for Hep B until 2008, it has been used on HIV patients since 2001.  If there were issues regarding pregnancy, they probably would have emerged already.  However, almost everything is possible and I agree it's a hard decision.

[stef2011]

hbvdna is useless for liver damage, we have fibroscan today

hbvdna useless to see if you can clear hbv or if you have many infected cells, whatever the values there is no corrispondence at all

ast/alt liver damage, not at all, again fibroscan will tell

today hbsag quant is the most important with this you know the chances to clear the virus once and for all, the chances to get cured!and high alt which means active immune system especially if hbvdna is low/und

[ggtm]

good idea stef. I shld start a new thread on this.

but now, the question is whether i really need to be on medication or not.
I know for HBe-antigen neg patients, there's no clear end-point for treatment. And some guidelines suggest not starting on medication and just monitor and treat when necessary.

So now, I do not know if DNA 7000IU/ml is considered high enough to treat. This dr I just went yesterday says its low and only above 20,000IU and elevated ALT then should consider to treat with meds. But my regular dr says its a jump from previous 966IU and stable levels before, so may result in a flare (but so far my ALT has been very low fortunately)
Which is more accurate?

[stef2011]

it is best to make a new thread for all other members that had tdf on pregnancy to give feed back and possibly suggest a good doctor

i am not a doctor so i can only suggest:

since etv is not safe for pregnancy it is good to stop it as soon as pregnant like you've done

i d start tdf immediately, if your hbvdna was low/und tdf should start its effect on virus very fast

tdf has no resistance and there are no issues reported about pregnancy and i d not worry about this, i d start it immediately because we dont know if hbvdna can get und in 3months, 6 months or longer.

[ggtm]

Could I ask if you are a female too?

Im not so comfortable with taking tenofovir throughout pregnancy (unless benefit outweighs risk by a lot), because, though its a cat B drug, if you take it everyday, you never know how it interferes with the developing fetus, esp the first 8 weeks when the crucial developments are taking place. My 2nd consideration is, I do not trust drug makers in some ways as after 10yrs, they may suddenly change their stand after finding some abnormalities in pregnancy women taking tnf.

[ggtm]

Oh, and for sure, if I start tenofovir from 2nd or 3rd trimester onwards, I will take it for a long time, no more stopes definitely. I do not mind taking for life, as long as I do not develop resistance to it.

[ggtm]

Stef, in my case, would you support the decision for me to STOP entecavir now (after restarting for just 11 days since my previous break in March) and try for a baby. Then 2nd trimester take tenofovir (if DNA rises to above what level?). Definitely, I will be taking tenofovir in 3rd trimester. Its just the 1st trimester that I dont wanna mess with any drugs as its the most impt period for the fetus. Im sorry that you may not have come across this scenerio, since you are not female. But Im sure there are many females like me who want to have a baby, but stick in the middle. I think Im having anxiety issues already..worrying so much!

And also, will it worsen the hbv virus if I stop now? Im more worried about mutations and resistance issues (I have been taking entecavir for 3yrs 3mths, then I stopped in March 2012, then got back again 11days ago.)

Thanks.

[veteranB]

that is crazy!

[stef2011]

the system is made exactly to serve big drug makers, small ones are not allowed to disturb and citizens the same

[stef2011]

guess what!

this is proibited by law, we have tried this way already but citizen cannot donate

[veteranB]

With regard to Replicor if they have no money to bring the drug to market why don't they then put a bulletin on their web site that they are excepting donations. We will all donate. How many sick HBV folks world wide. Money can be generated if they need to. So I think it is not that.

I think we should e-mail and invite Michelle Bazinett here and ask her what the deal is. With the power of internet it is possible to raise all the funds they need and to treatment say in Thailand or other country that permits it. It is not an issue. If Replicor people are ready and have the drug and want to help funds will be there.

[veteranB]

Unfortunately what you read here is what most of us are told.

For instance in the US all is measured really is HBV dna, and that is how progress is evaluated.

testing for mutants, genotype is not routinely done, or health insurance approved with some patients - it is labeled as investigation procedure and not necessary.

No surface antigen quantitative test is available. No Fibro Scan.

In fact most doctors here will tell you that still a biopsy is better then Fibro Scan. So there is really no need for it.

Once the person begins to understand the level of incompetence or flat out lies (for reasons that I will list below) about treatment they were told, they have no desire to see doctors, and argue with them, so they turn to internet and herbal self medication. Which makes health insurance companies happy.

it is a flat out business - a doctor has to get his bonus checks from the drug companies from writing prescriptions and at the same time not to upset the health insurance company he works with by doing too many tests. Even If the patient needs them. So given this system how can one really treat, and experiment and try to make a difference?

really honest and decent doctor cannot simply work in this system. I am saying it as a patient based on my own experience. The costs are high the quality is close to 0. If they miss routinely acute Hepatitis B then draw your own conclusions..

Some doctors don't even care anymore what they do if it is good for the patient or not. They do what is recommended by FDA..and the treatment recommendation provided by the drug company...  a safe bet to avoid a law suite just in case and stay in business for a while. Where everybody is happy and profiting except the patient if this is a serious illness.  some docs yes read it from the manual how to treat hepB.

You are lucky to be living in Europe where health care is a right not a service. And where doctors are not that dependent on drug and insurance companies how and with what to treat I am told.

The kind of a perfect world health care,  only is available to very rich people or politicians - which get it free also btw.  The rest of us in best case scenario is how much knowledge we can gather and how much our health insurance will allow our doctor to do and also a bit of help from God.

Look at the way at how clinical trials are set up for HBV today. Take for example Gilead GS9620 - imiquimod in pills .. How many patients did they take first in their trial? Why don't they expand the criteria and take people that have taken other drugs not just ETV?

The so called researchers that work with them what do they exactly do and how many people they are helping by doing such small trials of medication that works better then what we have today?

They monitor this forum, so why don't they come and respond and answer some questions? How come the fight against HBV is so slow if they are so commited?

So you see all the research or to be exact product testing is done and set up by the company like Gilead.

They could have just give them the drug and say here.. Try it on as many as you can and reports us the results. Report the results here on this forum where members could have spread the word in their countries to patients and doctors and government officials. And these companies would still make money. maybe not as killer profits as they do these days..

So that is why we as HBV community are stuck with lack of drugs. And lack of really solid treatment strategies of what works not to suppress the virus but to cure the patient.

Because this market  is dominated  by drug companies from one country where everything  has to bring money in order to do it - big money that buys influence and policy making.

These companies need to recover profits from all the time they put developing anti HIV agents. Which is what were are treated with really. In some way Europe is the same way they way they approve drugs.

So yes there is great hope in countries like China and Russia to provide at least the alternative way of doing things. Medicine cannot be for profit, it is emoral, it is not christian. At least they have the funds to pull something like this off now.

Because this is not working - running clinical on HBV drugs to approve them over a period of 5-7 years is ridiculous. Giving the devastating consequences chronic HBV carries for the patient and how much it raises the cost of health care overall. When there must be a simpler solution.

I see so many good reports about herbal treatment, various supplement. Why there is not trials on those? Why no one asks those wise old men in China and India that know herbs for their input?

So given the current situation, all we can do those of that know the truth about hbv treatment all we can do is share knowledge.  So people can at least know what to tell their doctor the next time they go and see him and what tests they need to be ordered. That is one way of beating this system. Which i truly believe will change because people are fed up with this and they understand where the problem is.