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.

[ono8ono]

another example that anti-viral drug do not work ; it is just good for the pharm compant to make $$$$!

[ggtm]

I forgot to mention that before baraclude treatment, my hbv dna was very high...probably about 8 log. So if it can be stable at less than 4 log, isn't it good? Or does hbv dna not make a difference at all in lowering risk of liver damage/cancer?

[ono8ono]

this info was posted by another member orientS

Up to March 2010, The Center for Liver Health at CUHK studied nine literature reporting HCC recurrence in chronic hepatitis B patients. 551 patients were studied, of which 204 had antiviral treatment and 347 were untreated controls. The analysis reveals that antiviral treatment was associated with over 40% risk reduction for HCC recurrence as compared with the untreated controls. Furthermore, antiviral treatment was associated with more than 85% reduction in risk of liver failure and more than 70% risk reduction in death after HCC treatment.

http://www.healthcanal.com/cancers/31578-Antiviral-Therapy-Can-Prevent-Liver-Cancer-Recurrence-CUHK-Represents-Draw-Asian-Pacific-Treatment-Guideline-for-Chronic-Hepatitis.html

[ggtm]

Thank you for your kind sharing. It is indeed insightful.

Qn. Does it mean if I go on anti-viral for the rest of my life, thats the best solution as it much lowers risk of liver damage/cancer?

My knowledge of hepB treatment is still not very good, and its great we have this forum to learn from one another!

[StephenCastlecrag]

I don't have any ready answers for your situation. Rules that allow patients to stop antiviral treatment successfully are still being developed. So we are grateful for your effort and hope to learn from your experience. Do keep us posted.

In the old days, seroconversion from HbeAg positive to HBeAg negative was considered the end point of treatment as HBeAg negative was taken to indicate a low replication phase, accompanied by very low hbvdna and normal ALT. But few years ago, they discovered mutant forms of the virus - pre-core or core promoter HBV variants - that prevent or decrease the production of HBeAg. So even though a patient is HBeAg negative, the virus is still actively replicating, as indicated by increased level of hbvdna. This is now called HBeAg negative chronic hepatitis (as distinct from HBeAg positive chronic hepatitis) and usually requires treatment.

So your doctor thinks that you may have the pre-core or core-promotor variant form of the virus. I am not a doctor, but I don't necessary agree with your doctor on this. The reasons are complicated but basically I believe there are differences between spontaneous HBeAg seroconversion and drug-induced seroconversion, as in your case.

I think it is a good idea to keep monitoring your hbvdna and ALT closely, as you may still have stopped successfully. HBV is tricky and there is a lot to discover.

Just my opinion.

[stef2011]

there are no reports about stopping baraclude and clearing the virus but there are reports on tenofovir and adefovir taken for long periods like 3-5 years and then stopping it, i dont remember exact numbers now but something like 40% cleared hbv definitively

since adefovir is similar to tenofovir but so weak that is not firstline drug anymore it is best to use tenofovir for this

[grmr]

@ ggtm. Just for my consideration, when eag conversion happened since you start taking Baraclude?

[ggtm]

Thank you for your valuable advice. I will continue monitoring, though 1 mth monitoring now seems quite stressful, as each time I will be very anxious of the lab results.

It seems that after stopping baraclude, I kinda feel something is missing and I actually do not mind being on medication for the rest of my life if that really can assure my liver health. But because I am planning for a 2nd child, I decided to stop for the moment.

I am thinking to take phyllanthus niruri and thymus gland supplements (bought off the pharmacy shelves type). I read that these 2 natural herbs will help improve liver health and immune system. In fact, some (though very rare) CHB carriers actually lost their HBsag after that them. Wonder if you support this?

[ggtm]

Thanks stef for your expert advice. It's great to still see you so active on the forum sharing your valuable advice to us newbies. Really appreciate it!

Are you saying tenofovir is more potent than baraclude in eliminating HBsag? How is the resistance to tenofovir? I will ask my dr abt this once I receive my lab results which I just took this week.

[ggtm]

by the way, would like to ask you on ur opinion about the risk level of liver damage/cancer for my case, based on my lab results.

And I read that high ALT is good as it means immune system attacking the virus. But on the other hand, I also read that we should always check that ALT is within normal range as it correlates to liver health. Which is true?

Thank you for sharing.

[ggtm]

I had HBeag- conversion after about 1 yr 3mths. It's about shortly after my DNA levels went undetected. And I continued Baraclude for another 2yrs after that before stopping recently.

[calmama]

"there are reports on tenofovir and adefovir taken for long periods like 3-5 years and then stopping it, i dont remember exact numbers now but something like 40% cleared hbv definitively"

40% HbsAg clearance on tenofovir or adefovir?  Seems way too high.  The link you provided a few days ago (https://docs.google.com/file/d/0B8E77QizhkLQdGdMamkwaXVFSDQ/edit?pli=1) showed only 10 out of 302 people cleared HbsAg after 30 months of treatment. That's only 3.3%.

[stef2011]

no it is not on tdf or adv, it is by stopping them all at once after long periods

these antivirals have also an immune suppressing effect so clearance on them will always be minimal but when you stop them you have a hbvdna flare which can activate immune system and clear hbv

[StephenCastlecrag]

Interest in Phyllanthus niruri has been around for a long time, in India, China, and many other countries. Over 10 years ago, an Indian doctor published a paper on its effectiveness in treating hepatitis B. However, it has never developed into a drug. Other researchers reported indifferent results. There are always issues involving composition(which specific strains, parts of plant to use), preparation and dosage. Bottom line is that there is not clinical trial that shows it is effective against HBV. I would not use it until  there is more evidence.

I have not heard of thymus gland supplements. Of course, there is Thymosin, an orphan drug approved for liver cancer by the FDA. I believe it is very expensive. It has never been approved for Hep B.

Vitamin D is worthwhile considering because many people are deficient and it has immune function in that certain receptors on a type of immune cells require it to work. So you may like to ask your doctor to test your Vitamin D level and take it if it is low or spend more time in the sun.
Drinking coffee also has a protective effect on the liver.

There is another person in the US heplist forum who has stopped ETV: his numbers are:
Stopped Baraclude after almost 4 years on 2/13/12

Measure          3/12      4/12      5/12      6/12      7/12      8/12

====================================================

AST                15        12        13        16        15        19

ALT                  16        18        18        19        21        39

DNA IU/ml        <20      <20      <20      149      2050    40

DNA copies      <116    <116    <116    867      11900  233

DNA                Un        Un        Detected       Detect  detect

He is waiting for his next Dr appointment, and we are waiting too.

Good luck with your second child.

[Nbm1]

I'm so glad I found this forum. I have so many questions. Thanks for your advice. One more thing, what is the name of the test I can take to see if i can clear this virus?

[stef2011]

these below are the charts of those stopping adefovir and clearing/not clearing, those with abnormal alt cleared very slowly while those with normal alt did not

you have to follow hbsag and alt to know if you are among those who clear, all other tests make no difference especially hbvdna.hbvdna was very high on those clearing and those not so dont loo for it

https://docs.google.com/file/d/0B8E77QizhkLQV1JsSFd5OUgzeUE/edit

[raja1972]

I am using  Phyllanthus niruri  along with other siddha (One of the indian medicine system) medications for the last one year.  the HBSAG got dropped to 3480 iu/ml from 7000+ and HBVDNA dropped to 984 iu/ml from 66K. But i need to stop  Phyllanthus niruri  due to some other health issue.  Now that i got cured from the other disease, my doctor asked to me continue  Phyllanthus niruri  along with other medications..  My HBSAG was 8890 two months ago (yes it went up from 3480 to 8890 due to other medical condition as i stopped  Phyllanthus niruri ) and now -on aug22nd - it is dropped to 6479.. a drop of 2400 in two months.. i will take monthly test and post results here.  BTW my dna count was 204 iu/ml (as on 30th Jun).  I did not take the HBVDNA after jun as it is costly ($120)

another member smile_boy is using LIV 52HB (an indian ayurveda medication) and has shown consistent reduction in HBSAG eventhrough during the initial stage of use of LIV52  HB, his HBSAG went up and now it is under 500 IU/ML.  

request smile_boy to post his results here

Note:  this is not endorsement for any of the medications that we are taking but just want to share what we are taking..  I would recommend it only after clearing HBSAG myself...

[StephenCastlecrag]

I am happy that your medicine is working for you, but as I said before, other people had tried it without success.

[ggtm]

May I know the phyllanthus niruri that you took, was it in capsules or powder form? How much do you take everyday? Any side effects when taking it? I actually thought herbs can't cause any negative things..am surprised your dr asked you to stop it for a while.

Appreciate your sharing very much. Thanks.

[ggtm]

I have actually been taking COenzyme Q10 for the past 1 mth. Anyone knows if it helps liver health or lowering HBV? I took it mainly for immune system, but I know coenzyme q10 helps o build stronger and healthier cells faster. Any comments appreciated!

[ggtm]

stef, I am unable to open the link for the googledocs. can you post the link here again? thank you!

[raja1972]

I am not taking Phyllanthus niruri  alone but with other siddha medications.  also my doctor did not guarantee to cure me of HBV.. He told me that he can take a call after completion of treatement for one year.. but before that one year period i have got into another issue and has to discontinue.. I am currently taking 6 medications and Phyllanthus niruri   is one among them.


ggtm:  I am not taking any capsule but either fresh leaves or powder of dried leaves... fresh leaves would be the best as it will give the maximum impact.. I am taking it twice a day 10 leaves each..doctor said that much would be enough..

I am also taking turmeric and pepper on a daily basis.. also taking vitamin d.  and some iron supplement in the form of siddha medicine ( to help my CD4 count..not sure)..

As i said earlier i am not recommending this to anyone to try but will do so once i am cured of HBV without any relapse

Note: in siddha , Phyllanthus niruri   has been a standard medicine for HEP A

[4est]

be careful with iron supplemental, because it can be not good for HBV patients.

(how can you get Phyllanthus niruri  - also this Phyllanthus niruri  exist on a  pils supplemental ? )

[ggtm]

May i ask where did you buy your phyllanthus niruri leaves? I couldnt find them in stores here or online.

Also, if my hbv dba remain under 2000IU/ml, does it mean I'm under immune-control phase, and that liver damage is under control?