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.

[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?