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HBeAg positive to negative
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HBeAg positive to negative

Hi,

I have Hep B for 16 years now (im now 30 years old), receive it from blood donation... Never mind that now. From 2004-2008 i received Lamivudine therapy and my liver enzymes got down to reasonable limits. They stayed there for 5, 6 years until my last blood control. Here is chronological results;

2008: AST 33, ALT 30, ALP 70, GGT 17, UBIL 10
2010: AST 42, ALT 46, ALP 66, GGT 16, UBIL 11
         HBsAg pos.>250 IU/mL, Anti-HBs neg, Anti-Hbc total positive,
         Anti-HBc IgM neg, HBeAg pos, Anti-HBe pos, HBV-DNA 791 IU/mL
2011: AST 32, ALT 47, ALP 76, GGT 19, UBIL 11
2012: AST 35, ALT 56, ALP 66, GGT 21, UBIL 15
2013: AST 72, ALT 156, ALP 59, GGT 24, UBIL 11
         HBsAg pos.9755 IU/mL, Anti-HBs neg, Anti-Hbc total positive,
         Anti-HBc IgM neg, HBeAg neg, Anti-HBe pos, HBV-DNA 5.45e+7 IU/mL

From what you can see my HBeAg turned from positive to negative and my liver enzymes and HBV-DNA started to raise.....

I'm waiting for specialist check in a few week but want some advices or opinions from any experiences, maybe...

Thank you all in advance..
Tags: HbeAg
27 Comments Post a Comment
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Avatar_m_tn
you worsen from wildtype to bcp/precore mutations, while hbeag positive has definitive clearance of hbv on tdf and pegintf hbeag negative has mcuh lower chances.just make the test for mutations but the most useful test is hbsag quant in iu/ml

hbeag is an old view it is not useful anymore to have hbeag neg but only low hbsag quantity on both hbeag pos or hbeag neg

also check fibroscan and possibly start therapy if you have liver damage
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Avatar_m_tn
What were your hbsag and hbv-dna levels in 2004(before start of treatment) and in 2008?Which antiviral are you taking right now? Doctors often suggest taking ursodiol/ursodeoxycholic acid 300mg for a few months so as to keep a check on the rise in the ast/alt levels.My mom's alt/ast levels rose to 100 during hbv treatment.After taking udiliv300 for 1 month those levels have gone down to 42 and 50.Next dosage will start within some days.But it is better to consult a doctor for required amount of dosage before taking such medicines.
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Avatar_m_tn
concerned about high ALT & AST...


taking sevibo for 1 yr then i decided to undergo pegintf.
stop taking sevibo for 1 month then started the mono pegintf.

before taking sevibo
HBV Viral load 640M copies/ML

after 1 yr of sevibo
HBV Viral load is 37 iu/ml

before pegintf:
HBsAg II Quantification 1,392 iu/ml
HBV Viral Load 37 iu ml

results- 24 weeks of  Pegintf
HBV Viral load is <6 iu/ml or 35 copies/ml
HBsAg II Quantification 314.90 iu/Ml

I understand the result is good.

what worries me is the consistent  high ALT
and SGOT result is high also (although test done once only after 24wks of pegintf)

ALT 64.60        (declining results)
SGPT 42.11    

i have mild fibrosis result before pegintf .
what will be the effect of consistent high alt in my liver?
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Avatar_m_tn
dont worry about ast-alt they have no danger to normal livers for just few years treatment and absolutely not a those levels, 1000 is a level of concern to cirrhosis patients while the others on mild fibrosis have no issues even on 1500

alt reflects the killing of infected cells by immune system with such result at 24weeks you re definitely going to clear in 48-72weeks.if you see a slower decline you may think of adding vitamin d3 if lower than 40-50ng/ml in blood or alinia or simvastatin but for now since hbsag decline is fast it is best not to mix, only if you find very low vit d3 it may be useful to take it immediately (we have trials were vitd3>30ng/ml had much higher clearance on pegint)

please update on your next hbsag results
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Avatar_m_tn

of course if your alt were not elevated there would have been no hbsag decline or any chance to clear hbv, just to make you understand how your alt are almost normal and make no damage at all:

i regressed cirrhosis with alt 40-50 on entecavir and now still around 30-40 on entecavir plus tenofovir which is absolutley best because i have little decrease of hbsag year per year, with alt less than 30 hbsg would not decrease
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Avatar_m_tn
Thank you so much stef. Your reply is much clearer than my doctor response.

My other concern is my dose of pegintf is not consistent coz of my WBC, Neutrophils and platelet count is low. Is this okay?
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Avatar_m_tn
use 180 dose, the lower dose dont work, response is low at 180 already

low plts are less than 20.000-25.000, if you have higher it is ok to keep the high dose.expert specialists are able to monitor you at these low plts, the bad ones are not experinced and are scared of any abnormal value

neutrophils can be as low as 0.5, what are your values?

how to keep less sides and higher wbc and plts:
melatonin
vit d3
liposomal vitamin c

if these fails instead of lowering pegintf dose there are drugs that increase plts
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Avatar_m_tn
if needed you can post on hcv community about peg sides effects and warning low plts and wbc and drugs used.pegintf has much heavier sides for hcv infection so they are more experienced on this, on hbv sides are milder
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Avatar_m_tn
my last  wbc  is 3.24 si units
platelet is 92
neutrophils 16.70

last dose was 135mcg.
my lowest platelet count drop to 52. No meds administer yet for platelet





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Avatar_f_tn
Fred, when you started interferon, how was your hbeag +/-, hbeab+/-?
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Avatar_m_tn
plts 52 is not sufficent to lower pegintf dose, you can reach 20-25 or use drugs to increase plts instead of lowering intf dose.135mcg dose has much lower chances of success

these are of course good being on intf whty dont you discuss the dose with your specialist or check with another intf experienced specialist too?

my last  wbc  is 3.24 si units
platelet is 92
neutrophils 16.70
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Avatar_m_tn
Kumusta experience mo sa Pginterferon??? any side effect experience???
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Avatar_m_tn
How long it will take to get result of HBsAg into Negative after taking Tenofovir. If the HBV DNA Quantity UI/ML drops from 7.03x10 ^6 to 6.72x10^4 in one month.
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Avatar_m_tn
1392 iu ml hbsag quantification
hbsag 3,165
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Avatar_m_tn
1392 iu ml hbsag quantification
hbsag 3,165
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Avatar_m_tn
i just had my cbc today

wbc is low 2.6
platelet is low 54
neutrophils is low .26

anc (absolute neutrohil count)  is 676

today i applied dose of 180mcg
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Avatar_m_tn
just minor side effects like joints and muscles pain
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Avatar_f_tn
What is hbsag 3165?
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Avatar_m_tn
wbc is low 2.6

try melatonin 20-30mg daily and see if wbc increases.melatonin increases wbc normally, let's see if it still increases wbc under pegintf.melatonin regulates sleep too so take it at night before going to bed, not during the day

neutrophils is low .26
this is low too, take both vit d3 10.000iu daily and liposomal vitamin c, this should boost machrofages function and maybe they will act to increase both wbc and neutrophils.i ll go check on hcv community what they do in your cases



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Avatar_m_tn
from hcv forum a good thread

http://www.medhelp.org/posts/Hepatitis-C/Low-WBC--RBC--Platelet--should-I-continue-treatment/show/1934195

You can't do anything about any of those numbers. If they get severe enough your doctor might prescribe "rescue" meds that will help, or might suggest reducing the dosage of your ribavirin, but you are not currently near to those levels. Each doctor does things slightly differently, but to give you a better idea of the problem numbers, most do not worry about platelets unless they go below 50 (and then consider Rx Promacta or transfusion), most do not worry about HGB until it goes below 10, and some let it go as low as 8 before taking action (Rx of procrit injections or possibly transfusions), and most do not worry about low WBC unless the ANC drops below 0.5, and then consider dose reduction, Rx Neupogen injections, or stopping tx.

During tx my HGB dropped as low as  10.1, my ANC dropped as low as 0.6 and my platelets dropped as low as 0.51. My doctor ordered more frequent testing (weekly) each time something dropped near to the cutoff  line, but each time the numbers bounced back a little on their own without intervention. I completed 48 weeks of tx in Sept 2012, without any rescue meds or dose reductions, and am now SVR.

You can do it, just make sure you have frequent tests whenever the numbers drop very low, as not everyone has them bounce back on their own!
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Avatar_m_tn
i got the drug to take in case of low anc, it is neupogen

so if your anc is 260 it would be best to consider neupogen and bring it back to more than 500 so you can keep therapy at 180mcg

it is very important to keep the 180mcg dose since you had response on hbsag, it would be too bad if you lose response
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Avatar_m_tn
screening test only and the other one is quantification
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Avatar_m_tn
yes my doctor discussed neupogen but since my anc is above 500, the dose was back to 180mcg.  For last 3 wks dose was 135mcg.

today i took 2,000iu of vitD3

have you administered neupogen? how long?
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Avatar_m_tn
have you administered neupogen? how long?

no, you should post on hcv forum, it is sure one has there

i dont even started pegintf add on yet, i am waiting for hbsag to rech lower values than 3600-4000iu/ml
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Avatar_m_tn
may i know what brand of liposomal vitamins is good/reliable.
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Avatar_m_tn
livonlabs
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Avatar_f_tn
Hi fred! What was your hbeag status when you started pegint? Which country are in your treatment?
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